KCC Infusion, LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

KCC INFUSION, LLC

Doing business as

Vicksburg Infusion Center

Practice address

2080 S Frontage Rd Ste 100B
Vicksburg, MS 39180-5328

Phone

(601) 482-4003

NPI assigned

May 21, 2021

Last updated

May 2, 2022By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• Vicksburg Infusion Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• KCC Infusion, LLC

  dba Shreveport Infusion Center

  • Infusion Therapy Clinic/Center
  • Shreveport, LA
  • NPI 1225794506

  4688076896

  Same PAC ID

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.

• KCC Infusion, LLC

  dba Shreveport Infusion Center

  • Infusion Therapy Clinic/Center
  • Shreveport, LA
  • NPI 1225794506
  NPD tax ID

Member of 1

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

• KCC, Inc

  dba Vital Care Rx

  • Home Infusion Agency
  • Shreveport, LA
  • NPI 1043520968

  Member Of

  NPD member

Locations

Practitioners 1

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.

• Olatunji Jonathan Oluwatade, MD

  • Infectious Disease Physician
  • Vicksburg, MS
  • NPI 1477677458
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1942875158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 23RD AVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014027",
            "telephone_number": "601-482-4003",
            "fax_number": "601-482-3948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 S FRONTAGE RD STE 100B",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805328",
            "telephone_number": "601-482-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KCC INFUSION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-21",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vicksburg Infusion Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vicksburg Infusion Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jenifer Justice, CRNP
• K McDaniel Inc
• Izzeddin Kamelmaz, MD
• Ashley L Karel, PMHNP-BC
• Simarjit Kaur, PA
• Kevin Keith Keen, D.M.D.
• Keeping Focus LLC.
• Logan Kelley, PHARM. D
• Madelyn Grace Kelly
• Rhonda Kemp, FNP

• Infusion Therapy Clinic/Center in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Infusion Therapy Clinic/Center in Mississippi

• 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.