Organization
MDK VENTURES LLC
Active
Other names
Medical Department Store
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN WILLIAM MCCORD (MANAGING MEMBER)
(941) 232-8585
Entity
Organization
Contact information
Practice address
1180 JACARANDA BLVD, VENICE, FL 34292-4501
(941) 497-2273
(877) 497-1030
Mailing address
1180 JACARANDA BLVD, VENICE, FL 34292-4501
(941) 497-2273
(877) 497-1030
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
HME 1608
FL
332BC3200X
Customized Equipment (DME)
HME 1608
FL
332BN1400X
Nursing Facility Supplies (DME)
HME 1608
FL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
HME 1608
FL
332BX2000X
Oxygen Equipment & Supplies (DME)
HME 1608
FL
335E00000X
Prosthetic/Orthotic Supplier
HME 1608
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025612900
—
FL
01
—
114400XX
PREFERRED CARE PROVIDER
FL
01
—
1419733
BCBS OF PA PROVIDER
FL
05
—
218895
—
FL
01
—
35633687
AETNA PROVIDER NUMBER
FL
01
—
629332
ANTHEM BCBS PROVIDER
FL
05
—
684602500
—
FL
05
—
686600096
—
FL
01
—
722Y3MD
BCBS OF MN PROVIDER
FL
01
—
R9698
BCBC PROVIDER NUMBER
FL
Enumeration date
07/01/2005
Last updated
02/27/2023
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