Provider Demographics
NPI:1851986566
Name:LUCKY QUEEN TRANSPORTATION LLC
Entity Type:Organization
Organization Name:LUCKY QUEEN TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-804-8058
Mailing Address - Street 1:4404 E OLTORF ST APT 2101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6050
Mailing Address - Country:US
Mailing Address - Phone:254-804-8058
Mailing Address - Fax:512-727-1847
Practice Address - Street 1:4404 E OLTORF ST APT 2101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6050
Practice Address - Country:US
Practice Address - Phone:254-804-8058
Practice Address - Fax:512-727-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle