Provider Demographics
NPI:1821362013
Name:BANKS, MARCUS
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:BANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7053 MELVIN RD
Mailing Address - Street 2:
Mailing Address - City:GILBERTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:36908-5131
Mailing Address - Country:US
Mailing Address - Phone:251-554-4542
Mailing Address - Fax:
Practice Address - Street 1:7053 MELVIN RD
Practice Address - Street 2:
Practice Address - City:GILBERTOWN
Practice Address - State:AL
Practice Address - Zip Code:36908-5131
Practice Address - Country:US
Practice Address - Phone:251-554-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)