Provider Demographics
NPI:1679153753
Name:HOULIHAN, MATTHEW TOD
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TOD
Last Name:HOULIHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20626 N 260TH AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7252
Mailing Address - Country:US
Mailing Address - Phone:623-698-3640
Mailing Address - Fax:
Practice Address - Street 1:20626 N 260TH AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-7252
Practice Address - Country:US
Practice Address - Phone:623-698-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34455343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)