Individual ProviderMatthew BallardStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address18701 N 67th Ave, Glendale, AZ 85308-7100(503) 580-1898PECOS EnrollmentBased on the most recent information from CMS, provider Matthew Ballard does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1366022766Provider TypeIndividualFull NameBallard, MatthewGenderMaleSole ProprietorYesEnumeration Date4/9/2021Last Updated5/17/2021Contact InformationPractice LocationPractice Address18701 N 67th Ave, Glendale, AZ 85308-7100Phone(503) 580-1898FaxUnlisted FaxMailing LocationMailing Address1937 N 1640 W, Provo, UT 84604-5626Phone(503) 580-1898FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer