Provider Demographics
NPI:1659684249
Name:K&R RAD LLC
Entity Type:Organization
Organization Name:K&R RAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-687-1483
Mailing Address - Street 1:4777 US HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7668
Mailing Address - Country:US
Mailing Address - Phone:903-663-8663
Mailing Address - Fax:903-663-0378
Practice Address - Street 1:8902 FLOYD CURL DR
Practice Address - Street 2:LIFECARE HOSPITAL - RADIOLOGY DEPARTMENT
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1681
Practice Address - Country:US
Practice Address - Phone:210-690-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM14462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UNASSIGNEDOtherAPPLYING FOR FIRST TIME