Provider Demographics
NPI:1104263268
Name:KCR HEALTHCARE, PLLC
Entity type:Organization
Organization Name:KCR HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, FNP
Authorized Official - Phone:804-921-1164
Mailing Address - Street 1:1805 MONUMENT AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-7005
Mailing Address - Country:US
Mailing Address - Phone:804-921-1164
Mailing Address - Fax:
Practice Address - Street 1:1805 MONUMENT AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-7005
Practice Address - Country:US
Practice Address - Phone:804-921-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024146888261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care