Healthcare Provider Details

I. General information

NPI: 1780855478
Provider Name (Legal Business Name): MDK VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8595 COLLEGE PKWY UNIT 170
FORT MYERS FL
33919-5191
US

IV. Provider business mailing address

752 COMMERCE DR SUITE 5
VENICE FL
34292-1744
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-6111
  • Fax: 239-482-6178
Mailing address:
  • Phone: 941-584-6154
  • Fax: 941-497-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number538 AHCA
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32 6681
License Number StateFL

VIII. Authorized Official

Name: MR. KEVIN WILLIAM MCCORD
Title or Position: MANAGING MEMBER
Credential:
Phone: 941-232-8585