MEDICARE: HEB NEUROSURGERY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	H4471	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001LM	OTHER	TX	BLUECROSS BLUESHILED

General Provider Information

NPI Number	:	1578751095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEB NEUROSURGERY PA

Provider Business Mailing Address
First Line	:	1604 HOSPITAL PKWY STE 501
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6932
Country	:	US
Telephone Number	:	817-510-5000
Fax Number	:	817-510-5001

Provider Business Practice Location Address
First Line	:	1604 HOSPITAL PKWY STE 501
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6932
Country	:	US
Telephone Number	:	817-510-5000
Fax Number	:	817-510-5001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID E KOSMOSKI
Credential	:	MD
Telephone Number	:	817-510-5000

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	04/08/2008

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Directions to “HEB NEUROSURGERY PA ” Practice Location

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