Healthcare Provider Details

I. General information

NPI: 1376799353
Provider Name (Legal Business Name): SBM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2654 W HORIZON RIDGE PKWY # B5-290
HENDERSON NV
89052-2803
US

IV. Provider business mailing address

2654 W HORIZON RIDGE PKWY B5-290
HENDERSON NV
89052-2803
US

V. Phone/Fax

Practice location:
  • Phone: 702-469-6526
  • Fax:
Mailing address:
  • Phone: 702-469-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSP-1100
License Number StateNV

VIII. Authorized Official

Name: SHAY B MCMINN
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.A..
Phone: 702-469-6526