Healthcare Provider Details

I. General information

NPI: 1891398319
Provider Name (Legal Business Name): HEALTHONE IRL PATHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4567 E 9TH AVE
DENVER CO
80220-3908
US

IV. Provider business mailing address

PO BOX 744326
ATLANTA GA
30374-4326
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-2250
  • Fax: 303-320-2361
Mailing address:
  • Phone: 954-777-0250
  • Fax: 866-262-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M SMITHAM
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 303-584-8119