=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699134882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUNT REGIONAL MEDICAL PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2016
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1080 E LENNON DR STE 3
-----------------------------------------------------
City | EMORY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75440-5253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-473-2060
-----------------------------------------------------
Fax | 903-473-2686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 AIR PARK AVE
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75402-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-408-1100
-----------------------------------------------------
Fax | 903-408-1129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STEVEN LEE BOLES
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 903-408-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 673930
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------