MEDICARE: MARCUS CONSTRUCTION LLC

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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1710718168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCUS CONSTRUCTION LLC

Provider Business Mailing Address
First Line	:	10201 WILSHIRE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-3024
Country	:	US
Telephone Number	:	505-828-1922
Fax Number	:	505-828-9153

Provider Business Practice Location Address
First Line	:	10201 WILSHIRE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-3024
Country	:	US
Telephone Number	:	505-828-1922
Fax Number	:	505-828-9153

Authorized Official
Title or Position	:	OWNER
Name	:	EDGAR MARCUS
Credential	:
Telephone Number	:	505-828-1922

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	09/24/2024

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Directions to “MARCUS CONSTRUCTION LLC ” Practice Location

Language	Start Address	Practice Location

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