Provider Demographics
NPI:1134452964
Name:MEDICAL HOME OFFICE, INC.
Entity type:Organization
Organization Name:MEDICAL HOME OFFICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:575-763-4057
Mailing Address - Street 1:2200 N MAIN ST STE 31
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3558
Mailing Address - Country:US
Mailing Address - Phone:575-763-4057
Mailing Address - Fax:575-763-4091
Practice Address - Street 1:2200 N MAIN ST
Practice Address - Street 2:STE 31
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3558
Practice Address - Country:US
Practice Address - Phone:575-763-4057
Practice Address - Fax:575-763-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty