Provider Demographics
NPI:1265631519
Name:MEDICAL VENTURES OF AMERICA
Entity Type:Organization
Organization Name:MEDICAL VENTURES OF AMERICA
Other - Org Name:LAKE REGIONAL URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-315-1651
Mailing Address - Street 1:910 OLD CAMP RD
Mailing Address - Street 2:PROF BUILDING 114
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162
Mailing Address - Country:US
Mailing Address - Phone:352-315-8881
Mailing Address - Fax:352-315-8883
Practice Address - Street 1:910 OLD CAMP RD
Practice Address - Street 2:PROF BLDG 114
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5604
Practice Address - Country:US
Practice Address - Phone:352-259-4322
Practice Address - Fax:352-259-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB902BOtherBLUE CROSS AND BLUE SHIEL
FLB902BOtherBLUE CROSS AND BLUE SHIEL