Provider Demographics
NPI:1003410473
Name:THE QUEENBEQUEEN COLLECTION
Entity Type:Organization
Organization Name:THE QUEENBEQUEEN COLLECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-433-5085
Mailing Address - Street 1:5285 HILLTOP RD APT F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5281
Mailing Address - Country:US
Mailing Address - Phone:704-433-5085
Mailing Address - Fax:
Practice Address - Street 1:5285 HILLTOP RD APT F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5281
Practice Address - Country:US
Practice Address - Phone:704-433-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier