Provider Demographics
NPI:1134510175
Name:GEM CITY CLINICAL LABORATORY, LLC
Entity Type:Organization
Organization Name:GEM CITY CLINICAL LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHISENHUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-760-9449
Mailing Address - Street 1:PO BOX 292012
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3560 MARSHALL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4916
Practice Address - Country:US
Practice Address - Phone:937-760-9449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2090245291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory