NPIMap

Organization Active NPI

MDK Ventures LLC

Doing business as Medical Department Store

  • Durable Medical Equipment & Medical Supplies
  • Fort Myers, FL
National Provider Identifier
1780855478
Registry record updated Mar 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
538 AHCA Issued in FL
Legal business name
MDK VENTURES LLC
Doing business as
Medical Department Store
Practice address
8595 College Pkwy
Unit 170
Fort Myers, FL 33919-5191
Phone
(239) 482-6111
Fax
(239) 482-6178
NPI assigned
Mar 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2010

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 538 AHCA FL Primary
Oxygen Equipment & Supplies (DME) 332BX2000X 32 6681 FL

Addresses

Primary practice location

8595 College Pkwy
Unit 170
Fort Myers, FL 33919-5191

Mailing address

752 Commerce Dr
Suite 5
Venice, FL 34292-1744
Phone (941) 584-6154

Other identifiers 1

IdentifierTypeStateIssuer
025612900MedicaidFL

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
O20100930045529 FL DME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Oxygen & Equipment 3476766528 Practice locations: Fort Myers, 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
    • Venice, FL
    • NPI 1043217391

    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 Ventures LLC8595 College Pkwy, Fort Myers, FL 33919-5191(239) 482-6111 Automatic Ext Defibrillator (AEDS) and/or Supplies|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 (E… 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

8595 College Pkwy
Ste 170
Fort Myers, FL 33919
Phone (239) 482-6111

NPI Registry JSON

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

{
    "created_epoch": "1205971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267401600000",
    "number": "1780855478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "752 COMMERCE DR",
            "address_2": "SUITE 5",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342921744",
            "telephone_number": "941-584-6154",
            "fax_number": "941-497-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8595 COLLEGE PKWY",
            "address_2": "UNIT 170",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339195191",
            "telephone_number": "239-482-6111",
            "fax_number": "239-482-6178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDK VENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-20",
        "last_updated": "2010-03-01",
        "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": "538 AHCA",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "FL",
            "license": "32 6681",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025612900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL DEPARTMENT STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2010; 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.