Provider Demographics
NPI:1386094100
Name:BASORE HOOVER, LLC
Entity type:Organization
Organization Name:BASORE HOOVER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-264-2273
Mailing Address - Street 1:610A MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3332
Mailing Address - Country:US
Mailing Address - Phone:903-264-2273
Mailing Address - Fax:
Practice Address - Street 1:610A MARYLAND DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3332
Practice Address - Country:US
Practice Address - Phone:903-264-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty