Provider Demographics
NPI:1174859961
Name:MDK VENTURES L.L.C.
Entity Type:Organization
Organization Name:MDK VENTURES L.L.C.
Other - Org Name:MEDICAL DEPARTMENT STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/GENERAL MANAGER
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:941-584-6154
Mailing Address - Street 1:752 COMMERCE DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1744
Mailing Address - Country:US
Mailing Address - Phone:941-584-6154
Mailing Address - Fax:941-584-6155
Practice Address - Street 1:3672 WEBBER ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-4413
Practice Address - Country:US
Practice Address - Phone:941-923-7556
Practice Address - Fax:941-927-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4423600004Medicare NSC