Organization
STAT LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENE P GEBELE MD (DIRECTOR)
(812) 332-8101
Entity
Organization
Contact information
Practice address
2201 W SUDBURY AVE, SUITE A, BLOOMINGTON, IN 47403-3737
(812) 332-8101
(812) 332-0435
Mailing address
2201 W SUDBURY DR, SUITE A, BLOOMINGTON, IN 47403-3737
(812) 332-8101
(812) 332-0435
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
15D0360697
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100283160A
—
IN
01
—
256020
MEDICARE PTAN
IN
Enumeration date
10/25/2005
Last updated
04/03/2009
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