Healthcare Provider Details

I. General information

NPI: 1013956051
Provider Name (Legal Business Name): GEORGE CARL BORST III PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ST.CHRISTOPHER DRIVE
ASHLAND KY
41101-7064
US

IV. Provider business mailing address

1201 ST. CHRISTOPHER DRIVE
ASHLAND KY
41101-7064
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-1101
  • Fax: 606-324-0404
Mailing address:
  • Phone: 606-324-1101
  • Fax: 606-324-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21922
License Number StateKY

VIII. Authorized Official

Name: DR. GEORGE C BORST III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 606-326-1101