Provider Demographics
NPI:1225794506
Name:KCC INFUSION, LLC
Entity Type:Organization
Organization Name:KCC INFUSION, LLC
Other - Org Name:SHREVEPORT INFUSION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-482-4003
Mailing Address - Street 1:8625 LINE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6107
Mailing Address - Country:US
Mailing Address - Phone:318-673-8360
Mailing Address - Fax:318-673-8360
Practice Address - Street 1:8625 LINE AVE STE B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6107
Practice Address - Country:US
Practice Address - Phone:318-673-8360
Practice Address - Fax:318-673-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy