Organization
ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN K. MATANKY M.D. (OWNER)
(520) 426-1000
Entity
Organization
Contact information
Practice address
1760 E FLORENCE BLVD, SUITE 120, CASA GRANDE, AZ 85122-4764
(520) 426-1000
(520) 426-1395
Mailing address
1760 E FLORENCE BLVD, SUITE 120, CASA GRANDE, AZ 85122-4764
(520) 426-1000
(520) 426-1395
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
22110
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344579
—
AZ
01
—
CH9210
RR MEDICARE
AZ
05
—
F00672
—
AZ
01
—
F66298
MERCY HEALTH PLANS
AZ
Enumeration date
08/30/2006
Last updated
03/17/2018
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