Basic Information
| Provider Information | |||||||||
| NPI: | 1851383517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRYSSOS | ||||||||
| FirstName: | BASIL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4390 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897024390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758820430 | ||||||||
| FaxNumber: | 7756888031 | ||||||||
| Practice Location | |||||||||
| Address1: | 1470 MEDICAL PKWY | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897034648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457650 | ||||||||
| FaxNumber: | 7756878457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 09/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 6678 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | A52334 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | EN467Z | 01 | NV | MEDICARE PTAN FOR CTPC | OTHER |