Provider Demographics
NPI:1356302830
Name:KENNETH H Z ISAACS PS
Entity Type:Organization
Organization Name:KENNETH H Z ISAACS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H Z
Authorized Official - Last Name:ISAACS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-525-1084
Mailing Address - Street 1:301 W POPLAR ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2800
Mailing Address - Country:US
Mailing Address - Phone:509-525-1084
Mailing Address - Fax:509-529-7866
Practice Address - Street 1:301 W POPLAR ST
Practice Address - Street 2:SUITE 230
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2800
Practice Address - Country:US
Practice Address - Phone:509-525-1084
Practice Address - Fax:509-529-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-01
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG115144300Medicare PIN