Provider Demographics
NPI:1417358334
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: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 1:1180 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:941-584-6154
Mailing Address - Fax:941-584-6155
Practice Address - Street 1:13030 LIVINGSTON RD
Practice Address - Street 2:STE 2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-5024
Practice Address - Country:US
Practice Address - Phone:239-529-2242
Practice Address - Fax:239-776-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies