Provider Demographics
NPI:1376439943
Name:BOZEMAN, MARVIN C
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:C
Last Name:BOZEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7631
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-0631
Mailing Address - Country:US
Mailing Address - Phone:614-440-2210
Mailing Address - Fax:
Practice Address - Street 1:3274 BEAGLE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7508
Practice Address - Country:US
Practice Address - Phone:614-440-2210
Practice Address - Fax:614-829-7694
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRU720354347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle