NPIMap

Organization Active NPI

Medical Ventures of America

  • Legal Medicine
  • Mount Dora, FL
National Provider Identifier
1053869487
Registry record updated Oct 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
ME77919 Issued in FL
Legal business name
MEDICAL VENTURES OF AMERICA
Practice address
16890 US Highway 441
Mount Dora, FL 32757-6705
Phone
(352) 315-1651
Fax
(352) 315-1703
NPI assigned
Sep 14, 2016
Organization subpart
Yes
Parent organization
LAKE REGIONAL URGENT CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2016

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

Authorized official

Name
Glenda Marti
Title
Billing Manager
Phone
(352) 315-1651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193200000X MULTI-SPECIALTY GROUP 173000000X ME77919 FL Primary

Addresses

Primary practice location

16890 US Highway 441
Mount Dora, FL 32757-6705

Mailing address

16890 US Highway 441
Mount Dora, FL 32757-6705
Phone (352) 315-1651

Other identifiers 1

IdentifierTypeStateIssuer
010331500MedicaidFL

Other names 1

  • LAKE REGIONAL PRIMARY CARE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medical Ventures of America3 organizations share this tax ID, including this one
Part of
Medical Ventures of America

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476144000000",
    "number": "1053869487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16890 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576705",
            "telephone_number": "352-315-1651",
            "fax_number": "352-315-1703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16890 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576705",
            "telephone_number": "352-315-1651",
            "fax_number": "352-315-1703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL VENTURES OF AMERICA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE REGIONAL URGENT CARE",
        "enumeration_date": "2016-09-14",
        "last_updated": "2016-10-11",
        "status": "A",
        "authorized_official_last_name": "MARTI",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "352-315-1651"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "FL",
            "license": "ME77919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010331500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE REGIONAL PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Dora, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.