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RANDALL SURGICAL GROUP, INC.

Company Details

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 (53 years ago)
Date of Dissolution: 20 Oct 2008 (17 years ago)
Date of Status Change: 20 Oct 2008 (17 years ago)
Identification Number: 000017606
ZIP code: 02904
County: Providence County
Purpose: LICENSED TO PRACTICE MEDICINE
Principal Address: Google Maps Logo ONE RANDALL SQUARE, PROVIDENCE, RI, 02904, USA

Agent

Name Role Address
DAVID J. MCOSKER, ESQ. Agent 120 WAYLAND AVENUE SUITE 5, PROVIDENCE, RI, 02906, USA

PRESIDENT

Name Role Address
STANLEY SIMON MD PRESIDENT ONE RANDALL SQUARE PROVIDENCE, RI 02940 USA

National Provider Identifier

NPI Number:
1770620023

Authorized Person:

Name:
DR. DAVID ROBERT CLOUTIER
Role:
VICE PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
4014545989

Filings

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: 17 May 2025

Sources: Rhode Island Department of State