MEDICARE: SBC VENTURES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1538859194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SBC VENTURES LLC

Provider Business Mailing Address
First Line	:	1601 E LAMAR BLVD STE 209
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-4464
Country	:	US
Telephone Number	:	817-766-6030
Fax Number	:	817-766-5942

Provider Business Practice Location Address
First Line	:	1601 E LAMAR BLVD STE 209
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-4464
Country	:	US
Telephone Number	:	817-766-6030
Fax Number	:	817-766-5942

Authorized Official
Title or Position	:	CEO
Name	:	MS. SHANNON BRADLEY
Credential	:	RN
Telephone Number	:	214-606-3177

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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Directions to “SBC VENTURES LLC ” Practice Location

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