Provider Demographics
NPI:1649966532
Name:STEPHENS MCQUEEN HOLDINGS LLC
Entity type:Organization
Organization Name:STEPHENS MCQUEEN HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DEMETRIUS
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-763-8486
Mailing Address - Street 1:11002 BELMONT RUN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-2170
Mailing Address - Country:US
Mailing Address - Phone:704-763-8486
Mailing Address - Fax:
Practice Address - Street 1:11002 BELMONT RUN LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-2170
Practice Address - Country:US
Practice Address - Phone:704-763-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)