Healthcare Provider Details

I. General information

NPI: 1417862061
Provider Name (Legal Business Name): MARCUS HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 CORY DR
DAYTON OH
45406-5912
US

IV. Provider business mailing address

1443 CORY DR
DAYTON OH
45406-5912
US

V. Phone/Fax

Practice location:
  • Phone: 937-307-7421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: