| Name: | George J. Jacewicz M.D., Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 07 Nov 1973 (51 years ago) |
| Identification Number: | 000033186 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 95 TOLLGATE ROAD, WARWICK, RI, 02886, USA |
| Purpose: | PHYSICIANS OFFICE SPECIALIST IN OTOLOGY |
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
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447502729 | 2012-10-10 | 2013-09-06 | 95 TOLL GATE RD, WARWICK, RI, 028864443, US | 95 TOLL GATE RD, WARWICK, RI, 028864443, US | |||||||||||||||||||||||||
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| Phone | +1 401-738-6111 |
| Fax | 4017320155 |
Authorized person
| Name | GEORGE J JACEWICZ |
| Role | OWNER |
| Phone | 4017386111 |
Taxonomy
| Taxonomy Code | 207Y00000X - Otolaryngology Physician |
| License Number | 4047 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | GJ00045 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| GEORGE J. JACEWICZ | Agent | 95 TOLLGATE ROAD, WARWICK, RI, 02886, USA |
| Name | Role | Address |
|---|---|---|
| GEORGE J JACEWICZ MD | PRESIDENT | 95 TOLLGATE ROAD WARWICK, RI 02886 USA |
| Number | Name | File Date |
|---|---|---|
| 202449557570 | Annual Report | 2024-03-26 |
| 202331444980 | Annual Report | 2023-03-20 |
| 202212853940 | Annual Report | 2022-03-07 |
| 202187788580 | Annual Report | 2021-01-22 |
| 202032758250 | Annual Report | 2020-01-16 |
| 201984454870 | Annual Report | 2019-01-14 |
| 201857727430 | Annual Report | 2018-02-05 |
| 201730046490 | Annual Report | 2017-01-12 |
| 201690358000 | Annual Report | 2016-01-11 |
| 201553913380 | Annual Report | 2015-01-16 |
Date of last update: 07 Apr 2025
Sources: Rhode Island Department of State
