Provider Demographics
NPI:1053381335
Name:HILLIS, THOMAS MICHAEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:HILLIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7301 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4100
Mailing Address - Country:US
Mailing Address - Phone:479-314-6248
Mailing Address - Fax:479-314-6159
Practice Address - Street 1:7301 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4100
Practice Address - Country:US
Practice Address - Phone:479-314-6248
Practice Address - Fax:479-314-6159
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3068207Q00000X
ARE-3068207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M029OtherBLUECROSSBLUESHIELD ARK
ARP00011418OtherRAILROAD MEDICARE/PALMETT
AR0790780001OtherPALMETTO GBA
AR521328OtherHEALTH LINK
AR020407900OtherBLACK LUNG PROGRAM
ARXX12984OtherHEALTH PLUS OF MICHIGAN
AR0062731OtherUMWA H&R FUNDS
AR145380001Medicaid
CA2231992OtherUNITED HEALTHCARE
AR02110033600OtherQUALCHOICE
AR7890433OtherAETNA INSURANCE COMPANY
CA2231992OtherUNITED HEALTHCARE
AR020407900OtherBLACK LUNG PROGRAM