Provider Demographics
NPI:1811199441
Name:GEORGE C BORST III MD PSC
Entity Type:Organization
Organization Name:GEORGE C BORST III MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BORST
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:606-326-1101
Mailing Address - Street 1:1201 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7064
Mailing Address - Country:US
Mailing Address - Phone:606-326-1101
Mailing Address - Fax:606-326-0404
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:PLAZA B SUITE 340
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2878
Practice Address - Country:US
Practice Address - Phone:606-326-1101
Practice Address - Fax:606-326-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005639Medicaid
KYCM3265OtherRAILROAD MEDICARE
KY65931537Medicaid
KY00031OtherMEDICARE
KY00031Medicare PIN