MEDICARE: 70820 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

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

General Provider Information

NPI Number	:	1346833985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	70820 VENTURES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 251549
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-1500
Country	:	US
Telephone Number	:	214-736-2700
Fax Number	:	214-736-2701

Provider Business Practice Location Address
First Line	:	3745 BROADWAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8101
Country	:	US
Telephone Number	:	239-689-7372
Fax Number	:	239-689-7569

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	THOMAS L WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	02/15/2021

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Directions to “70820 VENTURES, LLC ” Practice Location

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