1811199441 NPI number — GEORGE C BORST III MD PSC

Table of content: ALANE THOMAS (NPI 1295394096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811199441 NPI number — GEORGE C BORST III MD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE C BORST III MD PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811199441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 SAINT CHRISTOPHER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41101-7064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-326-1101
Provider Business Mailing Address Fax Number:
606-326-0404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 23RD ST
Provider Second Line Business Practice Location Address:
PLAZA B SUITE 340
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-326-1101
Provider Business Practice Location Address Fax Number:
606-326-0404
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORST
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-326-1101

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  21922 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810005639 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM3265 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65931537 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00031 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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