# CLARENCE H THOMAS MD LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619074812
- **Authorized official:** CLARENCE HENRY THOMAS MD (OWNER)
- **Authorized official phone:** (317) 856-5565

## Contact information

- **Practice address:** 6021 KENTUCKY AVENUE, INDIANAPOLIS, IN 46221
- **Practice address phone:** (317) 856-5565
- **Practice address fax:** (317) 856-1202
- **Mailing address:** 6021 KENTUCKY AVE, INDIANAPOLIS, IN 46221-9701
- **Mailing address phone:** (317) 856-5565
- **Mailing address fax:** (317) 856-1202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 03/26/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000384605 | ANTHEM | IN |
| 05 | — | 200365090 | — | IN |