Provider Demographics
NPI:1063423614
Name:NUDAK VENTURES, LLC
Entity type:Organization
Organization Name:NUDAK VENTURES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACQUISITIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-366-3440
Mailing Address - Street 1:6111 BURNET RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-3226
Mailing Address - Country:US
Mailing Address - Phone:512-454-9923
Mailing Address - Fax:512-454-9866
Practice Address - Street 1:6111 BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-3226
Practice Address - Country:US
Practice Address - Phone:512-454-9923
Practice Address - Fax:512-454-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28221332B00000X
332BP3500X, 333600000X, 3336H0001X, 251F00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141583OtherPK
2141583OtherPK
TX750870OtherBCBS
TX2095135-01Medicaid
6672840022Medicare NSC