Basic Information
| Provider Information | |||||||||
| NPI: | 1114023587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINCAID | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7203 W DESCHUTES AVE | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993367777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097371880 | ||||||||
| FaxNumber: | 5097371879 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 W 10TH AVE | ||||||||
| Address2: | STE 206 | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993366300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095855320 | ||||||||
| FaxNumber: | 5095855329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 07/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00030523 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 020050103 | 01 | WA | RR MEDICARE | OTHER | 1114339 | 05 | WA | MEDICAID | AK1518034 | 01 | WA | DEA | OTHER |