Healthcare Provider Details

I. General information

NPI: 1487608212
Provider Name (Legal Business Name): GEORGE CARL BORST III PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7064
US

IV. Provider business mailing address

1201 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7064
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-7000
  • Fax: 606-836-3157
Mailing address:
  • Phone: 606-836-7000
  • Fax: 606-836-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number200146
License Number StateKY

VIII. Authorized Official

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