=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750041943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUNT REGIONAL MEDICAL PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2021
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4264 STATE HIGHWAY 66 SUITE A
-----------------------------------------------------
City | CADDO MILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75135-6232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-527-0110
-----------------------------------------------------
Fax | 903-527-0111
-----------------------------------------------------
=====================================================
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 | 903-408-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------