1780619528 NPI number — KCC, INC.

Table of content: (NPI 1780619528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780619528 NPI number — KCC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KCC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VITAL CARE OF MERIDIAN/ WEST ALABAMA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780619528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 23RD AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39301-4586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-482-4003
Provider Business Mailing Address Fax Number:
601-482-3948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 23RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-4586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-482-4003
Provider Business Practice Location Address Fax Number:
601-482-3948
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILCHRIST
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
601-482-4003

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  111985 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 111985 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 111985 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 111985 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 111985 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 111985 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X , with the licence number: 111985 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000057068 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100002498 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-02164 . This is a "BCBS - DME" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 870001313 . This is a "MEDICARE LOCAL PART B" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 0000404202 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104747300 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510-43792 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00105652 . This is a "MEDICARE RR" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00330015 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01-25941 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25-86014 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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