Provider Demographics
NPI:1235732736
Name:HEALTHONE IRL PATHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:HEALTHONE IRL PATHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-584-8119
Mailing Address - Street 1:PO BOX 744326
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4326
Mailing Address - Country:US
Mailing Address - Phone:303-788-6130
Mailing Address - Fax:303-788-4996
Practice Address - Street 1:1455 S POTOMAC ST STE 101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4501
Practice Address - Country:US
Practice Address - Phone:303-695-2635
Practice Address - Fax:303-873-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000155314Medicaid