MEDICARE: MATTHEW GREGORY MCHUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor	D2-129	CO

General Provider Information

NPI Number	:	1538808076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW GREGORY MCHUGH

Provider Business Mailing Address
First Line	:	161 SATURN DR UNIT 1B
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3953
Country	:	US
Telephone Number	:	970-797-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 SATURN DR UNIT 1B
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3953
Country	:	US
Telephone Number	:	970-797-6791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/03/2022

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