Marcus Homer, ATC
Individual provider Active NPI Athletic Trainer · Hurricane, UT
NPI 1215906367 · NPPES record last updated Sep 17, 2008
Key facts
- NPI
- 1215906367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 6651606-4810 (UT)
- Practice address
- 75 N 2260 W
Hurricane, UT 84737-2034 - Phone
- (435) 635-6480
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096-002163 | IL | MD | Athletic Trainer |
| 6651606-4810 | UT | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096-002163 | IL | |
| Athletic Trainer | 2255A2300X | 6651606-4810 | UT | Yes |
Addresses
Primary practice location
75 N 2260 W
Hurricane, UT 84737-2034
Mailing address
34 Webb
La Verkin, UT 84745-5309
Phone (435) 635-9742
Other providers in Hurricane, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.