Provider Demographics
NPI:1215240874
Name:CHRIS G. YIANTSOU M.D., P.A.
Entity type:Organization
Organization Name:CHRIS G. YIANTSOU M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:GUS
Authorized Official - Last Name:YIANTSOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:817-283-5353
Mailing Address - Street 1:2600 TIBBETS DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6998
Mailing Address - Country:US
Mailing Address - Phone:817-283-5353
Mailing Address - Fax:817-283-5355
Practice Address - Street 1:2600 TIBBETS DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6998
Practice Address - Country:US
Practice Address - Phone:817-283-5353
Practice Address - Fax:817-283-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4781261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00LJ24Medicare UPIN