NPIMap

Organization Active NPI

MDK Ventures LLC

Doing business as Medical Department Store

  • Durable Medical Equipment & Medical Supplies
  • Venice, FL
National Provider Identifier
1043217391
Registry record updated Feb 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
HME 1608 Issued in FL
Legal business name
MDK VENTURES LLC
Doing business as
Medical Department Store
Practice address
1180 Jacaranda Blvd
Venice, FL 34292-4501
Phone
(941) 497-2273
Fax
(877) 497-1030
NPI assigned
Jul 1, 2005
Last updated
Feb 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kevin William McCord
Title
Managing Member
Phone
(941) 232-8585

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X HME 1608 FL Primary
Customized Equipment (DME) 332BC3200X HME 1608 FL
Nursing Facility Supplies (DME) 332BN1400X HME 1608 FL
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X HME 1608 FL
Oxygen Equipment & Supplies (DME) 332BX2000X HME 1608 FL
Prosthetic/Orthotic Supplier 335E00000X HME 1608 FL

Addresses

Primary practice location

1180 Jacaranda Blvd
Venice, FL 34292-4501

Mailing address

1180 Jacaranda Blvd
Venice, FL 34292-4501
Phone (941) 497-2273

Other identifiers 10

IdentifierTypeStateIssuer
025612900MedicaidFL
1419733OtherFLBCBS OF PA PROVIDER
629332OtherFLANTHEM BCBS PROVIDER
686600096MedicaidFL
684602500MedicaidFL
722Y3MDOtherFLBCBS OF MN PROVIDER
R9698OtherFLBCBC PROVIDER NUMBER
218895MedicaidFL
35633687OtherFLAETNA PROVIDER NUMBER
114400XXOtherFLPREFERRED CARE PROVIDER

Other names 1

  • Medical Department Store Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930034546 FL DME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 3476766528 Practice locations: Venice, FL

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • MDK Ventures L.L.C

    dba Medical Department Store

    • Durable Medical Equipment & Medical Supplies
    • Port Charlotte, FL
    • NPI 1962676189

    3476766528

    Same PAC ID
  • MDK Ventures L.L.C.

    dba Medical Department Store

    • Durable Medical Equipment & Medical Supplies
    • Sarasota, FL
    • NPI 1174859961

    3476766528

    Same PAC ID
  • MDK Ventures LLC

    dba Medical Department Store

    • Durable Medical Equipment & Medical Supplies
    • Fort Myers, FL
    • NPI 1780855478

    3476766528

    Same PAC ID

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
MDK Ventures1180 Jacaranda Blvd, Venice, FL 34292-4501(941) 497-2273 Commodes, Urinals, Bedpans|Continuous Passive Motion (CPM) Devices|Contracture Treatment Devices: Dynamic Splint|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Infrared Heating Pa… Does not accept assignmentParticipating since Mar 14, 2002

National Provider Directory

National Provider Directory
Tax ID family
MDK Ventures LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1180 Jacaranda Blvd
Venice, FL 34292
Phone (941) 497-2273

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677456000000",
    "number": "1043217391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924501",
            "telephone_number": "941-497-2273",
            "fax_number": "877-497-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924501",
            "telephone_number": "941-497-2273",
            "fax_number": "877-497-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDK VENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A",
        "authorized_official_last_name": "MCCORD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "941-232-8585",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "HME 1608",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "FL",
            "license": "HME 1608",
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "FL",
            "license": "HME 1608",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "FL",
            "license": "HME 1608",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "FL",
            "license": "HME 1608",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "FL",
            "license": "HME 1608",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025612900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF PA PROVIDER",
            "identifier": "1419733",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PROVIDER",
            "identifier": "629332",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "686600096",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "684602500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN PROVIDER",
            "identifier": "722Y3MD",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBC PROVIDER NUMBER",
            "identifier": "R9698",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218895",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "35633687",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE PROVIDER",
            "identifier": "114400XX",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Department Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medical Department Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.