MEDICARE: GRAND PEDIATRICS, P.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1396253910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND PEDIATRICS, P.S.

Provider Business Mailing Address
First Line	:	1402 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-5001
Country	:	US
Telephone Number	:	509-455-8220
Fax Number	:	509-455-9172

Provider Business Practice Location Address
First Line	:	1402 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-5001
Country	:	US
Telephone Number	:	509-455-8220
Fax Number	:	509-455-9172

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH P KINCAID
Credential	:	MD
Telephone Number	:	509-455-8220

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	01/17/2018

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Directions to “GRAND PEDIATRICS, P.S. ” Practice Location

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