| Name: | RANDALL SURGICAL GROUP, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 28 Sep 1972 (52 years ago) |
| Date of Dissolution: | 20 Oct 2008 (16 years ago) |
| Date of Status Change: | 20 Oct 2008 (16 years ago) |
| Identification Number: | 000017606 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | ONE RANDALL SQUARE, PROVIDENCE, RI, 02904, USA |
| Purpose: | LICENSED TO PRACTICE MEDICINE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770620023 | 2007-01-30 | 2020-08-22 | 1 RANDALL SQ, SUITE 406, PROVIDENCE, RI, 029042709, US | 1 RANDALL SQ, SUITE 406, PROVIDENCE, RI, 029042709, US | |||||||||||||||
|
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| Phone | +1 401-421-2928 |
| Fax | 4014545989 |
Authorized person
| Name | DR. DAVID ROBERT CLOUTIER |
| Role | VICE PRESIDENT |
| Phone | 4014212928 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DAVID J. MCOSKER, ESQ. | Agent | 120 WAYLAND AVENUE SUITE 5, PROVIDENCE, RI, 02906, USA |
| Name | Role | Address |
|---|---|---|
| STANLEY SIMON MD | PRESIDENT | ONE RANDALL SQUARE PROVIDENCE, RI 02940 USA |
| Number | Name | File Date |
|---|---|---|
| 200836529070 | Revocation Certificate For Failure to File the Annual Report for the Year | 2008-10-20 |
| 200812783490 | Revocation Notice For Failure to File An Annual Report | 2008-08-04 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
