Provider Demographics
NPI:1053303131
Name:FARRELL, TOMMIE (MD)
Entity type:Individual
Prefix:
First Name:TOMMIE
Middle Name:
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4372
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:1900 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2432
Practice Address - Country:US
Practice Address - Phone:325-670-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2882207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149118501Medicaid
NM81199Medicaid
NMB024OtherTRIWEST
TX112530101OtherFIRSTCARE COMMERCIAL
TX88616ZOtherBLUE CROSS / BLUE SHIELD
NM98102001Medicaid
OK100222280AMedicaid
TX112530102Medicaid
TX87397ZOtherHMO BLUE
NM81199OtherPRESBYTERIAN COMMERCIAL
TX149118502Medicaid
TX87397ZOtherHMO BLUE
NMB024OtherTRIWEST
NM98102001Medicaid