Provider Demographics
NPI:1073549440
Name:NUDAK VENTURES LLC
Entity Type:Organization
Organization Name:NUDAK VENTURES LLC
Other - Org Name:NUCARA IV SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACQUISITIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-366-3440
Mailing Address - Street 1:105 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2542
Mailing Address - Country:US
Mailing Address - Phone:641-684-4146
Mailing Address - Fax:641-684-5407
Practice Address - Street 1:105 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2542
Practice Address - Country:US
Practice Address - Phone:641-684-4146
Practice Address - Fax:641-684-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BP3500X, 333600000X
IA8083336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1617729OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IA6672840012Medicare NSC