| Name: | PLASTIC AND RECONSTRUCTIVE SURGERY, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 30 May 1975 (50 years ago) |
| Date of Dissolution: | 04 Sep 2013 (11 years ago) |
| Date of Status Change: | 04 Sep 2013 (11 years ago) |
| Identification Number: | 000019948 |
| ZIP code: | 02860 |
| County: | Providence County |
| Principal Address: | 333 SCHOOL STREET SUITE 305, PAWTUCKET, RI, 02860, USA |
| Purpose: | RECONSTRUCTIVE SURGERY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033212170 | 2006-09-06 | 2020-08-22 | 333 SCHOOL STREET, SUITE 305, PAWTUCKET, RI, 02860, US | 333 SCHOOL STREET, SUITE 305, PAWTUCKET, RI, 02860, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 401-728-7950 |
| Fax | 4017297952 |
Authorized person
| Name | CHARLES F JOHNSON |
| Role | PRESIDENT |
| Phone | 4017287950 |
Taxonomy
| Taxonomy Code | 2086S0122X - Plastic and Reconstructive Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED HEALTHCARE |
| Number | 1300103 |
| Issuer | BLUE CHIP |
| Number | 001120 |
| State | RI |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 20624 |
| State | RI |
| Issuer | CIGNA |
| Number | 0207928001 |
| Name | Role | Address |
|---|---|---|
| CHARLES F. JOHNSON, M.D. | Agent | 333 SCHOOL STREET, PAWTUCKET, RI, 02860, USA |
| Name | Role | Address |
|---|---|---|
| CHARLES F JOHNSON MD | PRESIDENT | 333 SCHOOL STREET PAWTUCKET, RI 02860 USA |
| Number | Name | File Date |
|---|---|---|
| 201327664810 | Articles of Dissolution | 2013-09-04 |
| 201325052600 | Annual Report | 2013-06-26 |
| 201321786860 | Revocation Notice For Failure to File An Annual Report | 2013-06-03 |
| 201288807020 | Annual Report | 2012-01-30 |
| 201175028260 | Annual Report | 2011-02-15 |
| 200955729870 | Annual Report | 2009-12-30 |
| 200839789480 | Annual Report | 2008-12-29 |
| 200805141380 | Annual Report | 2008-01-03 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
