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  5. Memorial X-Ray Services, Ltd.

Memorial X-Ray Services, Ltd.

Company Details

Name: Memorial X-Ray Services, Ltd.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 29 Jun 1973 (52 years ago)
Date of Dissolution: 28 Jan 2016 (9 years ago)
Date of Status Change: 28 Jan 2016 (9 years ago)
Identification Number: 000009855
ZIP code: 02920
County: Providence County
Principal Address: 171 EAST HILL DRIVE, CRANSTON, RI, 02920, USA
Purpose: PROFESSIONAL CORPORATION ENGAGED IN THE SPECIALTY OF RADIOLOGY
Fictitious names: Premier Diagnostic Imaging (trading name, 2006-04-27 - )

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1730294950 2006-08-20 2007-11-30 PO BOX 1908, PAWTUCKET, RI, 028621908, US 111 BREWSTER ST, PAWTUCKET, RI, 028604400, US

Contacts
Phone +1 401-729-2836
Fax 4017292721

Authorized person
Name MRS. CAROL J DESENA
Role ASSISTANT PATIENT ACCOUNTS MANAGER
Phone 4017292836

Taxonomy
Taxonomy Code 2085R0202X - Diagnostic Radiology Physician
License Number HOS00128
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 0009742557
State MA
Issuer MEDICAID
Number 0009000660
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEMORIAL X-RAY SERVICES, LTD. PROFIT SHARING PLAN 2014 050352200 2015-10-15 MEMORIAL X-RAY SERVICES, LTD. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-07-01
Business code 621510
Sponsor’s telephone number 4017226000
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017226000

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing BRADLEY SHAPIRO, M.D.
Valid signature Filed with authorized/valid electronic signature
MEMORIAL X-RAY SERVICES, LTD. PROFIT SHARING PLAN 2013 050352200 2014-06-03 MEMORIAL X-RAY SERVICES, LTD. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-07-01
Business code 621510
Sponsor’s telephone number 4017226000
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017226000

Signature of
Role Plan administrator
Date 2014-06-03
Name of individual signing BRADLEY SHAPIRO, M.D.
Valid signature Filed with authorized/valid electronic signature
MEMORIAL X-RAY SERVICES, LTD. PROFIT SHARING PLAN 2012 050352200 2013-08-26 MEMORIAL X-RAY SERVICES, LTD. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-07-01
Business code 621510
Sponsor’s telephone number 4017226000
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017226000

Signature of
Role Plan administrator
Date 2013-08-26
Name of individual signing BRADLEY SHAPIRO, M.D.
Valid signature Filed with authorized/valid electronic signature
MEMORIAL X-RAY SERVICES, LTD. PROFIT SHARING PLAN 2011 050352200 2012-10-03 MEMORIAL X-RAY SERVICES, LTD. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-07-01
Business code 621510
Sponsor’s telephone number 4017226000
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017226000

Signature of
Role Plan administrator
Date 2012-10-03
Name of individual signing BRADLEY SHAPIRO, M.D.
Valid signature Filed with authorized/valid electronic signature
MEMORIAL X-RAY SERVICES, LTD. DEFINED BENEFIT PENSION PLAN 2010 050352200 2011-12-22 MEMORIAL X-RAY SERVICES, LTD. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 621510
Sponsor’s telephone number 4017292800
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017292800

Signature of
Role Plan administrator
Date 2011-12-22
Name of individual signing BRADLEY SHAPIRO
Valid signature Filed with authorized/valid electronic signature
MEMORIAL X-RAY SERVICES, LTD. PROFIT SHARING PLAN 2010 050352200 2011-11-02 MEMORIAL X-RAY SERVICES, LTD. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-07-01
Business code 621510
Sponsor’s telephone number 4017226000
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017226000

Signature of
Role Plan administrator
Date 2011-11-02
Name of individual signing BRADLEY SHAPIRO, M.D.
Valid signature Filed with authorized/valid electronic signature
MEMORIAL X-RAY SERVICES, LTD. DEFINED BENEFIT PLAN 2010 050352200 2011-12-22 MEMORIAL X-RAY SERVICES, LTD. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 621510
Sponsor’s telephone number 4017292800
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017292800

Signature of
Role Plan administrator
Date 2011-12-22
Name of individual signing BRADLEY SHAPIRO
Valid signature Filed with authorized/valid electronic signature
MEMORIAL X-RAY SERVICES, LTD. PROFIT SHARING PLAN 2009 050352200 2011-03-22 MEMORIAL X-RAY SERVICES, LTD. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-07-01
Business code 621510
Sponsor’s telephone number 4017226000
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017226000

Signature of
Role Plan administrator
Date 2011-03-22
Name of individual signing BRADLEY SHAPIRO, M.D.
Valid signature Filed with authorized/valid electronic signature
MEMORIAL X-RAY SERVICES, LTD. DEFINED BENEFIT PENSION PLAN 2009 050352200 2011-03-29 MEMORIAL X-RAY SERVICES, LTD. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 621510
Sponsor’s telephone number 4017292800
Plan sponsor’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709

Plan administrator’s name and address
Administrator’s EIN 050352200
Plan administrator’s name MEMORIAL X-RAY SERVICES, LTD.
Plan administrator’s address 171 EAST HILL DRIVE, CRANSTON, RI, 029203709
Administrator’s telephone number 4017292800

Signature of
Role Plan administrator
Date 2011-03-29
Name of individual signing BRADLEY SHAPIRO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
E. COLBY CAMERON, ESQ. Agent 301 PROMENADE STREET, PROVIDENCE, RI, 02908, USA

PRESIDENT

Name Role Address
BRADLEY A SHAPIRO MD PRESIDENT 171 EAST HILL DRIVE CRANSTON, RI 02920 USA

Filings

Number Name File Date
201691368350 Articles of Dissolution 2016-01-28
201557793320 Annual Report 2015-03-19
201436084570 Annual Report 2014-02-24
201311269690 Annual Report 2013-02-11
201291269110 Annual Report 2012-03-20
201174750450 Annual Report 2011-02-10
201060101430 Annual Report 2010-03-10
200943648040 Annual Report 2009-03-04
200942480010 Statement of Change of Registered/Resident Agent Office 2009-02-20
200806450300 Annual Report 2008-01-24

Related by officers

E. COLBY CAMERON, ESQ.

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Related by address

No related companies by address

Date of last update: 05 Oct 2024

Sources: Rhode Island Department of State

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