MEDICARE: MR. MARCUS MCCOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	000029012497	NC

General Provider Information

NPI Number	:	1659206639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS MCCOY

Provider Business Mailing Address
First Line	:	5412 KRISTIN LN
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-9231
Country	:	US
Telephone Number	:	252-281-1307
Fax Number	:

Provider Business Practice Location Address
First Line	:	5412 KRISTIN LN
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-9231
Country	:	US
Telephone Number	:	252-281-1307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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Directions to “ MR. MARCUS MCCOY ” Practice Location

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