NPIMap

Organization Active NPI

KCC Infusion, LLC

Doing business as Shreveport Infusion Center

  • Infusion Therapy Clinic/Center
  • Shreveport, LA
National Provider Identifier
1225794506
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X
Legal business name
KCC INFUSION, LLC
Doing business as
Shreveport Infusion Center
Practice address
8625 Line Ave Ste B
Shreveport, LA 71106-6107
Phone
(318) 673-8360
Fax
(318) 673-8360
NPI assigned
Nov 11, 2021
Last updated
May 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brad Gilchrist
Title
Coo
Phone
(601) 482-4003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X NU Primary

Addresses

Primary practice location

8625 Line Ave Ste B
Shreveport, LA 71106-6107

Mailing address

8625 Line Ave Ste B
Shreveport, LA 71106-6107
Phone (318) 673-8360

Other names 1

  • Shreveport Infusion Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211228000900 LA Part B Supplier - Clinic/Group Practice 4688076896 Receives reassigned benefits from 2 practitioners
Practice locations: Shreveport, LA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
KCC Infusion LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • KCC Inc

    dba Vital Care of Meridian/ West Alabama

    • Home Infusion Therapy Pharmacy
    • Meridian, MS
    • NPI 1780619528

    Member Of

    NPD member

Locations

8625 Line Ave
Ste B
Shreveport, LA 71106
Phone (318) 673-8360

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1225794506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8625 LINE AVE STE B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711066107",
            "telephone_number": "318-673-8360",
            "fax_number": "318-673-8360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8625 LINE AVE STE B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711066107",
            "telephone_number": "318-673-8360",
            "fax_number": "318-673-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KCC INFUSION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-11",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A",
        "authorized_official_last_name": "GILCHRIST",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "601-482-4003"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shreveport Infusion Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shreveport Infusion Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.