Individual
DR. THOMAS HOUSTON BLACK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1145 INDIANAPOLIS ROAD, GREENCASTLE, IN 46135
(765) 653-8453
(765) 653-8493
Mailing address
1145 INDIANAPOLIS ROAD, GREENCASTLE, IN 46135
(765) 653-8453
(765) 653-8493
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01024692
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013568191
RAILROAD MEDICARE
IN
05
—
100210870A
—
IN
01
—
1790868016
GROUP NPI
IN
01
—
1851474167
NPI
IN
01
—
CM7380
GROUP PIN
IN
Enumeration date
10/23/2006
Last updated
12/20/2021
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