Basic Information
| Provider Information | |||||||||
| NPI: | 1013069046 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCUM | ||||||||
| FirstName: | BOBBY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | C-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 HAL GREER BOULEVARD | ||||||||
| Address2: | ATTN: TAMMIE SILVA | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045262200 | ||||||||
| FaxNumber: | 3045262139 | ||||||||
| Practice Location | |||||||||
| Address1: | 1340 HAL GREER BOULEVARD | ||||||||
| Address2: | ATTN: TAMMIE SILVA | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045262200 | ||||||||
| FaxNumber: | 3045262139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 47550 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7100115990 | 05 | KY | MEDICAID | 3046877 | 05 | OH | MEDICAID | P00836672 | 01 | WV | RR MEDICARE | OTHER | 7103206000 | 05 | WV | MEDICAID |