Basic Information
| Provider Information | |||||||||
| NPI: | 1942329263 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINCAID MEDICAL ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3016 LOCUST ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631031372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145310008 | ||||||||
| FaxNumber: | 3145310145 | ||||||||
| Practice Location | |||||||||
| Address1: | 3016 LOCUST ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631031372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145310008 | ||||||||
| FaxNumber: | 3145310145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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| AuthorizedOfficialLastName: | KINCAID | ||||||||
| AuthorizedOfficialFirstName: | ROSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3145310008 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R9N99 | MO | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.