Provider Demographics
NPI:1073840492
Name:GARY A MATTHYS MD PLC
Entity Type:Organization
Organization Name:GARY A MATTHYS MD PLC
Other - Org Name:MATTHYS ORTHOPAEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-241-9300
Mailing Address - Street 1:2301 25TH ST S
Mailing Address - Street 2:SUITE I
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6104
Mailing Address - Country:US
Mailing Address - Phone:701-241-9300
Mailing Address - Fax:701-235-4525
Practice Address - Street 1:213 STATE ST W
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3005
Practice Address - Country:US
Practice Address - Phone:701-241-9300
Practice Address - Fax:701-235-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8590207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP32046OtherHEALTHPARTNERS
MN6I410MAOtherBCBS MN
MN9809527OtherMEDICA
MN708457000Medicaid
SD7700312Medicaid
ND14488Medicaid
MNHP32046OtherHEALTHPARTNERS
NDN713392Medicare PIN
ND14488Medicaid