Healthcare Provider Details

I. General information

NPI: 1538859194
Provider Name (Legal Business Name): SBC VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E LAMAR BLVD STE 209
ARLINGTON TX
76011-4464
US

IV. Provider business mailing address

1601 E LAMAR BLVD STE 209
ARLINGTON TX
76011-4464
US

V. Phone/Fax

Practice location:
  • Phone: 817-766-6030
  • Fax: 817-766-5942
Mailing address:
  • Phone: 817-766-6030
  • Fax: 817-766-5942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANNON BRADLEY
Title or Position: CEO
Credential: RN
Phone: 214-606-3177