MEDICARE: BPH GROUP PLLC

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1184022022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BPH GROUP PLLC

Provider Business Mailing Address
First Line	:	305 CIMARRON TRL
Second Line	:	STE 180 B
City	:	IRVING
State	:	TX
Zip	:	75063-4508
Country	:	US
Telephone Number	:	972-401-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 CIMARRON TRL
Second Line	:	STE 180 B
City	:	IRVING
State	:	TX
Zip	:	75063-4508
Country	:	US
Telephone Number	:	972-401-8800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASON KOURI
Credential	:	MD
Telephone Number	:	972-401-8800

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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