Organization
ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE, PC
Active
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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