Provider Demographics
NPI: | 1073818183 |
---|---|
Name: | VENTRE MEDICAL ASSOCIATES LLC |
Entity type: | Organization |
Organization Name: | VENTRE MEDICAL ASSOCIATES LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PETER |
Authorized Official - Middle Name: | PAUL |
Authorized Official - Last Name: | VENTRE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 954-561-6222 |
Mailing Address - Street 1: | 7261 SHERIDAN ST STE 340 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOLLYWOOD |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33024-2726 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-561-6222 |
Mailing Address - Fax: | 954-990-7650 |
Practice Address - Street 1: | 1400 E OAKLAND PARK BLVD STE 210 |
Practice Address - Street 2: | |
Practice Address - City: | OAKLAND PARK |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33334-4400 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-561-6222 |
Practice Address - Fax: | 954-990-7650 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-01-20 |
Last Update Date: | 2025-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X, 101YP2500X, 103TC0700X, 103TC2200X, 1041C0700X, 2083A0300X, 363A00000X, 363LP0808X | ||
FL | 2084A0401X, 2084F0202X, 2084P0804X, 2084P0802X, 2084P0805X, 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 2083A0300X | Allopathic & Osteopathic Physicians | Preventive Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
No | 2084F0202X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 003931201 | Medicaid | |
FL | 003931206 | Medicaid | |
FL | 003931200 | Medicaid | |
FL | 003931207 | Medicaid | |
FL | 003931208 | Medicaid | |
FL | 003931209 | Medicaid | |
FL | 003931210 | Medicaid |