Healthcare Provider Details

I. General information

NPI: 1366957482
Provider Name (Legal Business Name): VENTURE MEDICAL OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 8TH AVE W
PALMETTO FL
34221-5120
US

IV. Provider business mailing address

7206 16TH AVE NW
BRADENTON FL
34209-1151
US

V. Phone/Fax

Practice location:
  • Phone: 941-544-0366
  • Fax: 941-212-6059
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER N PETREAS
Title or Position: MEMBER
Credential: PA
Phone: 941-400-7051