MEDICARE: CLARENCE HENRY THOMAS MD

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	207Q00000X	Family Medicine Physician	01027581	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000386020	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356326763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARENCE HENRY THOMAS MD

Provider Business Mailing Address
First Line	:	6021 KENTUCKY AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221
Country	:	US
Telephone Number	:	317-856-5565
Fax Number	:	317-856-1202

Provider Business Practice Location Address
First Line	:	6021 KENTUCKY AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221
Country	:	US
Telephone Number	:	317-856-5565
Fax Number	:	317-856-1202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	03/18/2021

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