Healthcare Provider Details

I. General information

NPI: 1043217391
Provider Name (Legal Business Name): MDK VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 JACARANDA BLVD
VENICE FL
34292-4501
US

IV. Provider business mailing address

1180 JACARANDA BLVD
VENICE FL
34292-4501
US

V. Phone/Fax

Practice location:
  • Phone: 941-497-2273
  • Fax: 877-497-1030
Mailing address:
  • Phone: 941-497-2273
  • Fax: 877-497-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHME 1608
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberHME 1608
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberHME 1608
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHME 1608
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHME 1608
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberHME 1608
License Number StateFL

VIII. Authorized Official

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