Healthcare Provider Details

I. General information

NPI: 1972504884
Provider Name (Legal Business Name): THOMAS MICHAEL HILLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 WINDY HILL DR
TEXARKANA AR
71854-8198
US

IV. Provider business mailing address

2900 SAINT MICHAEL DR STE 307
TEXARKANA TX
75503-2343
US

V. Phone/Fax

Practice location:
  • Phone: 870-330-4577
  • Fax: 903-614-3525
Mailing address:
  • Phone: 903-614-5356
  • Fax: 903-614-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC4830
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberF4867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: