Provider Demographics
NPI:1972987378
Name:KCS MEDICAL, INC
Entity type:Organization
Organization Name:KCS MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHARRER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:931-901-0870
Mailing Address - Street 1:1407 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3535
Mailing Address - Country:US
Mailing Address - Phone:931-901-0870
Mailing Address - Fax:931-901-0872
Practice Address - Street 1:1407 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3535
Practice Address - Country:US
Practice Address - Phone:931-901-0870
Practice Address - Fax:931-901-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013842Medicaid
TN103G708530Medicare PIN