Provider Demographics
NPI:1568643823
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:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTHYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-241-9300
Mailing Address - Street 1:2301 25TH ST S STE I
Mailing Address - Street 2:
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 1:2301 25TH ST S STE I
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6104
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:2007-11-15
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7700312Medicaid
HP32046OtherHEALTH PARTNERS
DH0802OtherRR MEDICARE
ND07030001OtherBCBS
9809527OtherMEDICA
MN708457000Medicaid
ND14488Medicaid
MN6I410MAOtherMN BCBS
MN708457000Medicaid
ND6180940001Medicare NSC