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Organization

KCC, INC

Active
Other names
Vital Care Rx
Organization subpart
No

Provider details

NPI number
Authorized official
BRAD GILCHRIST (COO)
(601) 482-4003
Entity
Organization

Contact information

Practice address
8625 LINE AVE STE A, SHREVEPORT, LA 71106-6107
(318) 673-8360
(318) 673-8940
Mailing address
1501 23RD AVE, MERIDIAN, MS 39301-4027
(601) 482-4003
(601) 482-3948

Taxonomy

Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
332B00000X
Durable Medical Equipment & Medical Supplies
006322-IR
LA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
006322-IR
LA
333600000X
Pharmacy
6322
LA
3336H0001X
Home Infusion Therapy Pharmacy
006322-IR
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2200429
LA
Enumeration date
10/13/2010
Last updated
07/10/2025
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