Provider Demographics
NPI:1659373132
Name:K C A S ENT INC.
Entity Type:Organization
Organization Name:K C A S ENT INC.
Other - Org Name:CHILD ASSESSMENT/FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE PRACTITIONE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUDWIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:815-568-0243
Mailing Address - Street 1:706 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-2457
Mailing Address - Country:US
Mailing Address - Phone:815-568-0243
Mailing Address - Fax:815-568-5350
Practice Address - Street 1:706 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-2457
Practice Address - Country:US
Practice Address - Phone:815-568-0243
Practice Address - Fax:815-568-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-13
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000890363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL341407830001Medicaid
IL210763Medicare UPIN