MEDICARE: KINCAID MEDICAL ASSOCIATES PC

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	207Q00000X	Family Medicine Physician	R9N99	MO

General Provider Information

NPI Number	:	1942329263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINCAID MEDICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	3016 LOCUST ST
Second Line	:	SUITE 104
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1372
Country	:	US
Telephone Number	:	314-531-0008
Fax Number	:	314-531-0145

Provider Business Practice Location Address
First Line	:	3016 LOCUST ST
Second Line	:	SUITE 104
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1372
Country	:	US
Telephone Number	:	314-531-0008
Fax Number	:	314-531-0145

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROSA KINCAID
Credential	:	M.D.
Telephone Number	:	314-531-0008

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	02/02/2017

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