Healthcare Provider Details

I. General information

NPI: 1467978668
Provider Name (Legal Business Name): HEALTHONE IRL PATHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HAMPDEN AVE
ENGLEWOOD CO
80113-2702
US

IV. Provider business mailing address

PO BOX 744326
ATLANTA GA
30374-4326
US

V. Phone/Fax

Practice location:
  • Phone: 954-717-0275
  • Fax:
Mailing address:
  • Phone: 561-402-4256
  • 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: MICHAEL J DAVIS
Title or Position: AUTHORIZED OFFICIAL
Credential: COO
Phone: 561-402-4256