Provider Demographics
| NPI: | 1487221834 |
|---|---|
| Name: | VENTRE MEDICAL ASSOCIATES LLC |
| Entity Type: | Organization |
| Organization Name: | VENTRE MEDICAL ASSOCIATES LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| 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: | 7261 SHERIDAN ST STE 100B |
| Practice Address - Street 2: | |
| Practice Address - City: | HOLLYWOOD |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33024-2708 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 954-561-6222 |
| Practice Address - Fax: | 954-990-7650 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | VENTRE MEDICAL ASSOCIATES LLC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2021-06-04 |
| Last Update Date: | 2024-04-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 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 | 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 | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent 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 | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 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 |
