Provider Demographics
NPI:1790989754
Name:SOS BUISNESS TRUST
Entity Type:Organization
Organization Name:SOS BUISNESS TRUST
Other - Org Name:STAGNER ORTHOPEDIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRUSTEE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BJ
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:615-868-7626
Mailing Address - Street 1:3918 DICKERSON PIKE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-1328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 STONECREST PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6826
Practice Address - Country:US
Practice Address - Phone:615-459-7560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4335E00000X
TN3335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier