Healthcare Provider Details

I. General information

NPI: 1295410165
Provider Name (Legal Business Name): GEM CITY PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W 1ST ST STE 800
DAYTON OH
45402-1150
US

IV. Provider business mailing address

118 W 1ST ST STE 800
DAYTON OH
45402-1150
US

V. Phone/Fax

Practice location:
  • Phone: 937-345-1436
  • Fax:
Mailing address:
  • Phone: 937-345-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW RYAN NOORDSIJ-JONES
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 937-321-8698