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  5. PROVIDENCE CARDIOLOGY, INC.

PROVIDENCE CARDIOLOGY, INC.

Company Details

Name: PROVIDENCE CARDIOLOGY, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 31 Jul 1978 (47 years ago)
Identification Number: 000031881
ZIP code: 02916
County: Providence County
Principal Address: 400 PLEASANT ST APT 16, RUMFORD, RI, 02916, USA
Purpose: CARDIOLOGY AND INTERNAL MEDICINE

Industry & Business Activity

NAICS

621111 Offices of Physicians (except Mental Health Specialists)

This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau

Companies doing Offices of physicians (except mental health specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790856888 2006-11-13 2009-04-03 1 RANDALL SQ, SUITE 305, PROVIDENCE, RI, 029042709, US 1 RANDALL SQ, SUITE 305, PROVIDENCE, RI, 029042709, US

Contacts
Phone +1 401-521-0700
Fax 4015210906

Authorized person
Name MR. JACK HUG KLIE
Role PRESIDENT
Phone 4015210700

Taxonomy
Taxonomy Code 207RC0000X - Cardiovascular Disease Physician
License Number 4568
State RI
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS
Number 849
State RI
Issuer BLUE CHIP
Number 001218
State RI
Issuer MEDICAID
Number 9002630
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PROVIDENCE CARDIOLOGY, INC. PROFIT SHARING PLAN 2013 050378227 2014-02-13 PROVIDENCE CARDIOLOGY, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-08-01
Business code 621111
Sponsor’s telephone number 4015210700
Plan sponsor’s address ONE RANDALL SQUARE, SUITE 305, PROVIDENCE, RI, 029042774

Signature of
Role Plan administrator
Date 2014-02-13
Name of individual signing JACK H. KLIE, M.D.
Valid signature Filed with authorized/valid electronic signature
PROVIDENCE CARDIOLOGY, INC. PROFIT SHARING PLAN 2012 050378227 2013-06-05 PROVIDENCE CARDIOLOGY, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-08-01
Business code 621111
Sponsor’s telephone number 4015210700
Plan sponsor’s address ONE RANDALL SQUARE, SUITE 305, PROVIDENCE, RI, 029042774

Signature of
Role Plan administrator
Date 2013-06-05
Name of individual signing JACK H. KLIE, M.D.
Valid signature Filed with authorized/valid electronic signature
PROVIDENCE CARDIOLOGY, INC. PROFIT SHARING PLAN 2011 050378227 2012-09-04 PROVIDENCE CARDIOLOGY, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-08-01
Business code 621111
Sponsor’s telephone number 4015210700
Plan sponsor’s address ONE RANDALL SQUARE, SUITE 305, PROVIDENCE, RI, 029042774

Plan administrator’s name and address
Administrator’s EIN 050378227
Plan administrator’s name PROVIDENCE CARDIOLOGY, INC.
Plan administrator’s address ONE RANDALL SQUARE, SUITE 305, PROVIDENCE, RI, 029042774
Administrator’s telephone number 4015210700

Signature of
Role Plan administrator
Date 2012-09-04
Name of individual signing JACK H. KLIE, M.D.
Valid signature Filed with authorized/valid electronic signature
PROVIDENCE CARDIOLOGY, INC. PROFIT SHARING PLAN 2010 050378227 2011-06-03 PROVIDENCE CARDIOLOGY, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-08-01
Business code 621111
Sponsor’s telephone number 4015210700
Plan sponsor’s address ONE RANDALL SQUARE, SUITE 305, PROVIDENCE, RI, 029042774

Plan administrator’s name and address
Administrator’s EIN 050378227
Plan administrator’s name PROVIDENCE CARDIOLOGY, INC.
Plan administrator’s address ONE RANDALL SQUARE, SUITE 305, PROVIDENCE, RI, 029042774
Administrator’s telephone number 4015210700

Signature of
Role Plan administrator
Date 2011-06-03
Name of individual signing JACK H. KLIE, M.D.
Valid signature Filed with authorized/valid electronic signature
PROVIDENCE CARDIOLOGY, INC. PROFIT SHARING PLAN 2009 050378227 2010-06-12 PROVIDENCE CARDIOLOGY, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1978-08-01
Business code 621111
Sponsor’s telephone number 4015210700
Plan sponsor’s address ONE RANDALL SQUARE, SUITE 305, PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 050378227
Plan administrator’s name PROVIDENCE CARDIOLOGY, INC.
Plan administrator’s address ONE RANDALL SQUARE, SUITE 305, PROVIDENCE, RI, 02904
Administrator’s telephone number 4015210700

Signature of
Role Plan administrator
Date 2010-06-11
Name of individual signing JACK H. KLIE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JOHN A ORLANDO Agent 400 PLEASANT ST APT 16, RUMFORD, RI, 02916, USA

PRESIDENT

Name Role Address
JACK H KLIE PRESIDENT 41 TALLWOOD DR SEEKONK, MA 02771 USA

Filings

Number Name File Date
202451252380 Annual Report 2024-04-16
202451107130 Statement of Change of Registered/Resident Agent 2024-04-15
202449672390 Revocation Notice For Failure to Maintain a Registered Office 2024-03-28
202448694050 Registered Office Not Maintained 2024-01-03
202326110090 Annual Report 2023-01-18
202208338200 Annual Report 2022-01-20
202187951470 Annual Report 2021-01-27
202031480800 Annual Report 2020-01-08
201984092450 Annual Report 2019-01-09
201754646230 Annual Report 2017-12-06

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3904867306 2020-04-29 0165 PPP 1 RANDALL SQ Suite 305, PROVIDENCE, RI, 02904-2774
Loan Status Date 2022-02-09
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 19300
Loan Approval Amount (current) 19300
Undisbursed Amount 0
Franchise Name -
Lender Location ID 33371
Servicing Lender Name Bristol County Savings Bank
Servicing Lender Address 29 Broadway, TAUNTON, MA, 02780-3269
Rural or Urban Indicator U
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address PROVIDENCE, PROVIDENCE, RI, 02904-2774
Project Congressional District RI-01
Number of Employees 4
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 243908
Originating Lender Name Freedom National Bank, A Division of
Originating Lender Address GREENVILLE, RI
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 19491.93
Forgiveness Paid Date 2021-04-26

Related by officers

JOHN A ORLANDO

H R MOVING DELIVERY SERVICES LLC TAX SERVICES OF RHODE ISLAND LLC

Related by address

400 PLEASANT ST APT 16, RUMFORD, RI, 02916, USA

TAX SERVICES OF RHODE ISLAND LLC

Date of last update: 07 Apr 2025

Sources: Rhode Island Department of State

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