Provider Demographics
NPI:1780300954
Name:BORSTING LLC
Entity type:Organization
Organization Name:BORSTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BORSTING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-316-0627
Mailing Address - Street 1:9450 SW GEMINI DR
Mailing Address - Street 2:PMB 98694
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7105
Mailing Address - Country:US
Mailing Address - Phone:541-316-0627
Mailing Address - Fax:
Practice Address - Street 1:2450 NE MARY ROSE PL STE 205
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7132
Practice Address - Country:US
Practice Address - Phone:541-316-0627
Practice Address - Fax:541-325-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty