MDK Ventures L.L.C

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1313157 Issued in FL

Legal business name

MDK VENTURES L.L.C

Doing business as

Medical Department Store

Practice address

4265 Tamiami TRL
Unit E
Port Charlotte, FL 33980-2152

Phone

(941) 637-7330

Fax

(941) 637-6582

NPI assigned

Apr 18, 2008

Organization subpart

No

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 1

Addresses

Other identifiers 1

Other names 1

• Medical Department Store Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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
  • 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
• MDK Ventures LLC

  dba Medical Department Store

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

  3476766528

  Same PAC ID

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

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.

• MDK Ventures L.L.C.

  dba Medical Department Store

  • Durable Medical Equipment & Medical Supplies
  • Venice, FL
  • NPI 1043546864
  NPD tax ID
• MDK Ventures L.L.C.

  dba Medical Department Store

  • Durable Medical Equipment & Medical Supplies
  • Sarasota, FL
  • NPI 1174859961
  NPD tax ID
• MDK Ventures L.L.C.

  dba Medical Department Store

  • Durable Medical Equipment & Medical Supplies
  • Naples, FL
  • NPI 1417358334
  NPD tax ID
• MDK Ventures LLC

  dba Medical Department Store

  • Durable Medical Equipment & Medical Supplies
  • Venice, FL
  • NPI 1043217391
  NPD tax ID
• MDK Ventures LLC

  dba Medical Department Store

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

Locations

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1962676189",
    "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": "877-497-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4265 TAMIAMI TRL",
            "address_2": "UNIT E",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802152",
            "telephone_number": "941-637-7330",
            "fax_number": "941-637-6582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDK VENTURES L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2010-08-17",
        "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": "1313157",
            "primary": true
        }
    ],
    "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"
        }
    ]
}

• Erin Hays McKeown, PMHNP-BC
• Duane McKown, RPH
• Christopher McLain, APRN
• Angela M McPhillips, DNP, RN
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• Durable Medical Equipment & Medical Supplies in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.