=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053103358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SBS LUXE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2025
-----------------------------------------------------
Last Update Date | 06/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13100 YELLOWSTONE WAY
-----------------------------------------------------
City | PROVIDENCE VILLAGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76227-5629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-404-2277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 90
-----------------------------------------------------
City | AUBREY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76227-0249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-404-2277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHARUNDOLYN B SHAW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-404-2277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------