MEDICARE: DR. THOMAS F MARREN 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	4301082611	MI
2	207Q00000X	Family Medicine Physician	45881	WI
3	207Q00000X	Family Medicine Physician	MD2011-0630	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1034894	OTHER		PREFERREDONE
3	099K5MA	OTHER	MN	BCBS OF MN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	TM082611	OTHER	MI	BLUE CROSS BLUE SHIELD MI

General Provider Information

NPI Number	:	1952309833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS F MARREN MD

Provider Business Mailing Address
First Line	:	1001 W BROADWAY
Second Line	:	PMS -FARMINGTON COMMUNITY HEALTH CENTER
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-327-4796
Fax Number	:	505-325-9113

Provider Business Practice Location Address
First Line	:	1001 W BROADWAY
Second Line	:	PMS -FARMINGTON COMMUNITY HEALTH CENTER
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-327-4796
Fax Number	:	505-325-9113

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/30/2011

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Directions to “ DR. THOMAS F MARREN MD” Practice Location

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