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Organization
MEDICAL VENTURES OF AMERICA LLC
Active
Organization
MEDICAL VENTURES OF AMERICA LLC
Active
Other names
LAKE REGIONAL URGENT CARE
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DELEGGE MD (OWNER)
(843) 697-0400
Entity
Organization
Contact information
Practice address
16890 US HIGHWAY 441, MOUNT DORA, FL 32757-6705
(352) 250-5546
Mailing address
16890 US HIGHWAY 441, MOUNT DORA, FL 32757-6705
(352) 250-5546
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D1004910
MEDICARE CLIA #
FL
05
—
266435600
—
FL
01
—
34537
BLUE GRP PROV #
FL
01
—
B902B
BLUE SHIELD FACILITY #
FL
Enumeration date
04/10/2006
Last updated
03/03/2025
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