MEDICARE: MDK VENTURES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	HME 1608	FL
2	332BN1400X	Nursing Facility Supplies (DME)	HME 1608	FL
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	HME 1608	FL
4	332BX2000X	Oxygen Equipment & Supplies (DME)	HME 1608	FL
5	335E00000X	Prosthetic/Orthotic Supplier	HME 1608	FL
6	332B00000X	Durable Medical Equipment & Medical Supplies	HME 1608	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1419733	OTHER	FL	BCBS OF PA PROVIDER
3	629332	OTHER	FL	ANTHEM BCBS PROVIDER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	722Y3MD	OTHER	FL	BCBS OF MN PROVIDER
7	R9698	OTHER	FL	BCBC PROVIDER NUMBER
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	35633687	OTHER	FL	AETNA PROVIDER NUMBER
10	114400XX	OTHER	FL	PREFERRED CARE PROVIDER

General Provider Information

NPI Number	:	1043217391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDK VENTURES LLC

Provider Business Mailing Address
First Line	:	1180 JACARANDA BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-4501
Country	:	US
Telephone Number	:	941-497-2273
Fax Number	:	877-497-1030

Provider Business Practice Location Address
First Line	:	1180 JACARANDA BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-4501
Country	:	US
Telephone Number	:	941-497-2273
Fax Number	:	877-497-1030

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. KEVIN WILLIAM MCCORD
Credential	:
Telephone Number	:	941-232-8585

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	02/27/2023

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Directions to “MDK VENTURES LLC ” Practice Location

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