Healthcare Provider Details

I. General information

NPI: 1134452964
Provider Name (Legal Business Name): MEDICAL HOME OFFICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N MAIN ST STE 31
CLOVIS NM
88101-3558
US

IV. Provider business mailing address

2200 N MAIN ST STE 31
CLOVIS NM
88101-3558
US

V. Phone/Fax

Practice location:
  • Phone: 575-763-4057
  • Fax: 575-763-4091
Mailing address:
  • Phone: 575-763-4057
  • Fax: 575-763-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY CHARLES HILLIS
Title or Position: OWNER/PRINCIPAL
Credential: D.O.
Phone: 575-763-4057