Provider Demographics
NPI:1194832626
Name:NUDAK VENTURES, LLC
Entity Type:Organization
Organization Name:NUDAK VENTURES, LLC
Other - Org Name:NUCARA HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-366-3440
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:IA
Mailing Address - Zip Code:50621-0815
Mailing Address - Country:US
Mailing Address - Phone:641-366-3114
Mailing Address - Fax:641-366-2167
Practice Address - Street 1:118 CENTER ST
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:IA
Practice Address - Zip Code:50621-7822
Practice Address - Country:US
Practice Address - Phone:641-366-3114
Practice Address - Fax:641-366-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0220228Medicaid
IA0220228Medicaid