Healthcare Provider Details

I. General information

NPI: 1518527852
Provider Name (Legal Business Name): SBC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 ELMIRA ST SW
WASHINGTON DC
20032-2248
US

IV. Provider business mailing address

97 ELMIRA ST SW
WASHINGTON DC
20032-2248
US

V. Phone/Fax

Practice location:
  • Phone: 202-670-4860
  • Fax:
Mailing address:
  • Phone: 202-670-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KIANNA FOWLKES
Title or Position: CEO
Credential:
Phone: 202-670-4860