Healthcare Provider Details

I. General information

NPI: 1821316530
Provider Name (Legal Business Name): ISAAC KENNETH HURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MAPLEWOOD AVE
RONCEVERTE WV
24970-8016
US

IV. Provider business mailing address

2148 STONE HOUSE RD
CALDWELL WV
24925-7026
US

V. Phone/Fax

Practice location:
  • Phone: 304-793-2220
  • Fax:
Mailing address:
  • Phone: 304-290-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24968
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number24968
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: