| 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) |
| 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: 06 Oct 2024
Sources: Rhode Island Department of State
