Healthcare Provider Details

I. General information

NPI: 1053381335
Provider Name (Legal Business Name): THOMAS MICHAEL HILLIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-6248
  • Fax: 479-314-6159
Mailing address:
  • Phone: 479-314-6248
  • Fax: 479-314-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-3068
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3068
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: