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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
1291U00000XClinical Medical Laboratory200146KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
34007701OTHERKYMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000063697OTHERKYBLUE CROSS
2MEDICAID 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 : 1487608212
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGE CARL BORST III PSC
Provider Business Mailing Address
First Line : 1201 SAINT CHRISTOPHER DR
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7064
Country : US
Telephone Number : 606-836-7000
Fax Number : 606-836-3157
Provider Business Practice Location Address
First Line : 1201 SAINT CHRISTOPHER DR
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7064
Country : US
Telephone Number : 606-836-7000
Fax Number : 606-836-3157
Authorized Official
Title or Position : DIRECTOR
Name : DR. GEORGE C BORST III
Credential : M.D.
Telephone Number : 606-326-1101
Provider Enumeration Date : 05/19/2006
Last Update Date : 05/11/2015

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