Provider Demographics
NPI:1780619528
Name:KCC, INC.
Entity type:Organization
Organization Name:KCC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-482-4003
Mailing Address - Street 1:1501 23RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4586
Mailing Address - Country:US
Mailing Address - Phone:601-482-4003
Mailing Address - Fax:601-482-3948
Practice Address - Street 1:1501 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4586
Practice Address - Country:US
Practice Address - Phone:601-482-4003
Practice Address - Fax:601-482-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111985332B00000X, 332BC3200X, 332BP3500X, 332BX2000X, 333600000X, 3336H0001X, 3336C0003X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000057068Medicaid
AL100002498Medicaid
AL515-02164OtherBCBS - DME
MS870001313OtherMEDICARE LOCAL PART B
MS0000404202Medicaid
104747300OtherOWCP
AL510-43792OtherBCBS
MSP00105652OtherMEDICARE RR
MS00330015Medicaid
01-25941OtherNCPDP
25-86014OtherNCPDP
104747300OtherOWCP
=========OtherHUMANA MILITARY