Provider Demographics
NPI:1619074812
Name:CLARENCE H THOMAS MD LLC
Entity Type:Organization
Organization Name:CLARENCE H THOMAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-856-5565
Mailing Address - Street 1:6021 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-9701
Mailing Address - Country:US
Mailing Address - Phone:317-856-5565
Mailing Address - Fax:317-856-1202
Practice Address - Street 1:6021 KENTUCKY AVENUE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221
Practice Address - Country:US
Practice Address - Phone:317-856-5565
Practice Address - Fax:317-856-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200365090Medicaid
IN000000384605OtherANTHEM
IN200365090Medicaid
IN233820Medicare PIN