Provider Demographics
NPI:1427265628
Name:R. SCOTT KINKADE MD PC
Entity type:Organization
Organization Name:R. SCOTT KINKADE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KINKADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:928-649-7800
Mailing Address - Street 1:PO BOX 3848
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2607
Mailing Address - Country:US
Mailing Address - Phone:928-649-7800
Mailing Address - Fax:928-649-3929
Practice Address - Street 1:294 W HIGHWAY 89A
Practice Address - Street 2:SUITE 211
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3754
Practice Address - Country:US
Practice Address - Phone:928-649-7800
Practice Address - Fax:928-649-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ62725Medicare ID - Type Unspecified
AZG21011Medicare UPIN