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General NPI Number Information
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NPI Number | 1487608212
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Entity Type | Organization
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Legal Business Name | GEORGE CARL BORST III PSC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 1201 SAINT CHRISTOPHER DR
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City | ASHLAND
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State | KY
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Zip | 41101-7064
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Country | US
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Telephone | 606-836-7000
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Fax | 606-836-3157
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Provider Business Mailing Address
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Address Line | 1201 SAINT CHRISTOPHER DR
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City | ASHLAND
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State | KY
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Zip | 41101-7064
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Country | US
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Telephone | 606-836-7000
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Fax | 606-836-3157
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GEORGE C BORST III
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Credential | M.D.
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Telephone | 606-326-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 200146
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License Number State | KY
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