=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851865224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALIODX INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2019
-----------------------------------------------------
Last Update Date | 01/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 N 5TH ST STE 600
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23219-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-944-1904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 737 N 5TH ST STE 600
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23219-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-944-1904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ANNAMARIE BONANNO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-944-1904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------