Provider Demographics
NPI:1821594235
Name:ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATANKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-426-1000
Mailing Address - Street 1:1100 S DOBSON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6160
Mailing Address - Country:US
Mailing Address - Phone:520-426-1000
Mailing Address - Fax:520-426-1395
Practice Address - Street 1:1100 S DOBSON RD STE 203
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6160
Practice Address - Country:US
Practice Address - Phone:520-426-1000
Practice Address - Fax:520-426-1395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22110207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty