Provider Demographics
NPI:1376200832
Name:GENTLE TOUCH LABORATORY LLC
Entity Type:Organization
Organization Name:GENTLE TOUCH LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-292-6563
Mailing Address - Street 1:PO BOX 1782
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-1782
Mailing Address - Country:US
Mailing Address - Phone:386-205-2207
Mailing Address - Fax:866-462-5823
Practice Address - Street 1:118 CONNER ST NE
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2470
Practice Address - Country:US
Practice Address - Phone:386-205-2207
Practice Address - Fax:866-462-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2243126OtherCLIA