Provider Demographics
NPI:1790444644
Name:HEALIX RX PATHOLOGY, LLC
Entity Type:Organization
Organization Name:HEALIX RX PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMOL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-661-1500
Mailing Address - Street 1:1620 CENTRAL AVE RM 202
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4575
Mailing Address - Country:US
Mailing Address - Phone:307-635-8700
Mailing Address - Fax:
Practice Address - Street 1:1620 CENTRAL AVE RM 202
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4575
Practice Address - Country:US
Practice Address - Phone:307-635-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular GeneticsGroup - Multi-Specialty
No207ZC0008XAllopathic & Osteopathic PhysiciansPathologyClinical InformaticsGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty