1043217391 NPI number — MDK VENTURES LLC

Table of content: MRS. MEGAN G BAKER LMFT (NPI 1952829459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043217391 NPI number — MDK VENTURES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MDK VENTURES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043217391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1180 JACARANDA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34292-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-497-2273
Provider Business Mailing Address Fax Number:
877-497-1030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 JACARANDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34292-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-497-2273
Provider Business Practice Location Address Fax Number:
877-497-1030
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  HME 1608 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: HME 1608 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X , with the licence number: HME 1608 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: HME 1608 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: HME 1608 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: HME 1608 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 025612900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1419733 . This is a "BCBS OF PA PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 629332 . This is a "ANTHEM BCBS PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 686600096 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 684602500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 722Y3MD . This is a "BCBS OF MN PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: R9698 . This is a "BCBC PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 218895 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35633687 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 114400XX . This is a "PREFERRED CARE PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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