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NPI Code Detail

MEDICARE: GEORGE CARL BORST III PSC

MEDICARE: GEORGE CARL BORST III PSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RE0101XEndocrinology, Diabetes & Metabolism Physician21922KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15605OTHERKYMEDICARE
2CM3265OTHERKYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013956051
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGE CARL BORST III PSC
Provider Business Mailing Address
First Line : 1201 ST. CHRISTOPHER DRIVE
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7064
Country : US
Telephone Number : 606-324-1101
Fax Number : 606-324-0404
Provider Business Practice Location Address
First Line : 1201 ST.CHRISTOPHER DRIVE
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7064
Country : US
Telephone Number : 606-324-1101
Fax Number : 606-324-0404
Authorized Official
Title or Position : PRESIDENT
Name : DR. GEORGE C BORST III
Credential : M.D.
Telephone Number : 606-326-1101
Provider Enumeration Date : 06/05/2006
Last Update Date : 12/05/2014

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