Provider Demographics
NPI:1487608212
Name:GEORGE CARL BORST III PSC
Entity type:Organization
Organization Name:GEORGE CARL BORST III PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BORST
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:606-326-1101
Mailing Address - Street 1:1201 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7064
Mailing Address - Country:US
Mailing Address - Phone:606-836-7000
Mailing Address - Fax:606-836-3157
Practice Address - Street 1:1201 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7064
Practice Address - Country:US
Practice Address - Phone:606-836-7000
Practice Address - Fax:606-836-3157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200146291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000063697OtherBLUE CROSS
WV3810006274Medicaid
KY4007701OtherMEDICARE
KY3790137800Medicaid
WV3810006274Medicaid
KY4007701Medicare ID - Type UnspecifiedMEDICARE