| Name: | PAWTUXET VALLEY MEDICAL, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 07 Apr 1976 (49 years ago) |
| Date of Dissolution: | 29 Mar 2017 (8 years ago) |
| Date of Status Change: | 29 Mar 2017 (8 years ago) |
| Identification Number: | 000015949 |
| ZIP code: | 02816 |
| County: | Kent County |
| Principal Address: | 982 TIOGUE AVENUE, COVENTRY, RI, 02816, USA |
| Purpose: | MEDICAL PRACTICES |
| NAICS: | 62 - Health Care and Social Assistance |
| Fictitious names: |
Pawtuxet Valley Urgent Care (trading name, 2003-10-28 - ) pawtuxet valley medical and surgical services (trading name, 1983-05-23 - ) |
| Historical names: |
Pawtuxet Valley Medical and Surgical Services of Rhode Island,Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043431018 | 2007-05-01 | 2008-02-29 | 982 TIOGUE AVE, COVENTRY, RI, 028166167, US | 982 TIOGUE AVE, COVENTRY, RI, 028166167, US | |||||||||||||||||||||||||
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| Phone | +1 401-821-6800 |
| Fax | 4018218513 |
Authorized person
| Name | DANIEL F. COLLINS |
| Role | PRESIDENT |
| Phone | 4018216800 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 4612 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID DME |
| Number | 0190006 |
| State | RI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAWTUXET VALLEY MEDICAL, INC. 401(K) PROFIT SHARING PLAN | 2015 | 050370168 | 2016-09-06 | PAWTUXET VALLEY MEDICAL, INC. | 38 | |||||||||||||||||||||||
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| PAWTUXET VALLEY MEDICAL, INC. 401(K) PROFIT SHARING PLAN | 2014 | 050370168 | 2015-07-30 | PAWTUXET VALLEY MEDICAL, INC. | 34 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2015-07-30 |
| Name of individual signing | DANIEL COLLINS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1988-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 4018216800 |
| Plan sponsor’s address | 982 TIOGUE AVENUE, COVENTRY, RI, 02816 |
Signature of
| Role | Plan administrator |
| Date | 2014-03-27 |
| Name of individual signing | DANIEL COLLINS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| EVERETT PETRONIO, JR. ESQ. | Agent | 931 JEFFERSON BOULEVARD SUITE 2004, WARWICK, RI, 02886, USA |
| Name | Role | Address |
|---|---|---|
| DANIEL F COLLINS MD | PRESIDENT | 982 TIOGUE AVENUE COVENTRY, RI 02816 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 1991-11-25 | Pawtuxet Valley Medical and Surgical Services of Rhode Island,Inc. | PAWTUXET VALLEY MEDICAL, INC. |
| Number | Name | File Date |
|---|---|---|
| 201739118710 | Articles of Dissolution | 2017-03-29 |
| 201730145210 | Annual Report | 2017-01-16 |
| 201692364540 | Annual Report | 2016-02-12 |
| 201555986030 | Annual Report | 2015-02-28 |
| 201436344070 | Annual Report | 2014-02-27 |
| 201312523520 | Annual Report | 2013-02-24 |
| 201289861490 | Annual Report | 2012-02-20 |
| 201181910430 | Statement of Change of Registered/Resident Agent | 2011-09-06 |
| 201176297430 | Annual Report | 2011-03-07 |
| 201058589350 | Annual Report | 2010-02-16 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
