Provider Demographics
NPI:1043217391
Name:MDK VENTURES LLC
Entity type:Organization
Organization Name:MDK VENTURES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-232-8585
Mailing Address - Street 1:1180 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4501
Mailing Address - Country:US
Mailing Address - Phone:941-497-2273
Mailing Address - Fax:877-497-1030
Practice Address - Street 1:1180 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4501
Practice Address - Country:US
Practice Address - Phone:941-497-2273
Practice Address - Fax:877-497-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHME 1608332B00000X, 332BC3200X, 332BN1400X, 332BP3500X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025612900Medicaid
FL1419733OtherBCBS OF PA PROVIDER
FL629332OtherANTHEM BCBS PROVIDER
FL686600096Medicaid
FL684602500Medicaid
FL722Y3MDOtherBCBS OF MN PROVIDER
FLR9698OtherBCBC PROVIDER NUMBER
FL218895Medicaid
FL35633687OtherAETNA PROVIDER NUMBER
FL114400XXOtherPREFERRED CARE PROVIDER
FL686600096Medicaid