MEDICARE: S&B MEDICAL EMPLOYMENT AGENCY 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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1669216107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S&B MEDICAL EMPLOYMENT AGENCY LLC

Provider Business Mailing Address
First Line	:	PO BOX 2550
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75030-2550
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	7601 CHURCHILL WAY APT 1639
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1945
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Authorized Official
Title or Position	:	OWNER
Name	:	SHANE E LALL
Credential	:
Telephone Number	:	214-227-2457

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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