Provider Demographics
NPI:1467610402
Name:CHARLES A KINCAID PSC
Entity Type:Organization
Organization Name:CHARLES A KINCAID PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-897-1891
Mailing Address - Street 1:4001 DUTCHMANS LN STE 6B
Mailing Address - Street 2:SUBURBAN MEDICAL PLAZA I
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4738
Mailing Address - Country:US
Mailing Address - Phone:502-897-1891
Mailing Address - Fax:502-897-1893
Practice Address - Street 1:4001 DUTCHMANS LN STE 6B
Practice Address - Street 2:SUBURBAN MEDICAL PLAZA I
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4738
Practice Address - Country:US
Practice Address - Phone:502-897-1891
Practice Address - Fax:502-897-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY141642086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty