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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