1861448086 NPI number — DR. CHRISTOPHER ANDREW BORST MD

Table of content: DR. CHRISTOPHER ANDREW BORST MD (NPI 1861448086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861448086 NPI number — DR. CHRISTOPHER ANDREW BORST MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORST
Provider First Name:
CHRISTOPHER
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORST
Provider Other First Name:
CHRISTOPHER
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861448086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1818 HENDERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201-2619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-758-2602
Provider Business Mailing Address Fax Number:
803-253-8896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 21ST AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29577-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-626-9379
Provider Business Practice Location Address Fax Number:
843-448-0707
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  9560 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 095603 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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