Healthcare Provider Details

I. General information

NPI: 1780619528
Provider Name (Legal Business Name): KCC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 23RD AVE
MERIDIAN MS
39301-4586
US

IV. Provider business mailing address

1501 23RD AVE
MERIDIAN MS
39301-4027
US

V. Phone/Fax

Practice location:
  • Phone: 601-482-4003
  • Fax: 601-482-3948
Mailing address:
  • Phone: 601-482-4003
  • Fax: 601-482-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number111985
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number111985
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number111985
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number111985
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number111985
License Number StateAL
# 7
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRAD GILCHRIST
Title or Position: COO
Credential:
Phone: 601-482-4003