Provider Demographics
NPI:1144432642
Name:K.A.D.C., LLC
Entity type:Organization
Organization Name:K.A.D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYSAW
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:210-797-8812
Mailing Address - Street 1:5540 OLD SEGUIN ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78219-1043
Mailing Address - Country:US
Mailing Address - Phone:210-797-8812
Mailing Address - Fax:210-310-1602
Practice Address - Street 1:5540 OLD SEGUIN ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-1043
Practice Address - Country:US
Practice Address - Phone:210-797-8812
Practice Address - Fax:210-310-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010166305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$OtherSOCIAL SECURITY NUMBER