Provider Demographics
NPI:1154956092
Name:GEM LOGISTICS INC
Entity type:Organization
Organization Name:GEM LOGISTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ASENSOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-762-2611
Mailing Address - Street 1:4 SCANDINAVIA AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1641
Mailing Address - Country:US
Mailing Address - Phone:508-762-2611
Mailing Address - Fax:508-796-5736
Practice Address - Street 1:4 SCANDINAVIA AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1641
Practice Address - Country:US
Practice Address - Phone:508-762-2611
Practice Address - Fax:508-796-5736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110159111AMedicaid
MA110159111Medicaid