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  5. Richard P. San Antonio, M.D., FACC, Inc.

Richard P. San Antonio, M.D., FACC, Inc.

Company Details

Name: Richard P. San Antonio, M.D., FACC, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Revoked Entity
Date of Organization in Rhode Island: 06 Aug 1985 (39 years ago)
Date of Dissolution: 12 Sep 2023 (a year ago)
Date of Status Change: 12 Sep 2023 (a year ago)
Identification Number: 000035446
ZIP code: 02886
County: Kent County
Principal Address: 215 TOLLGATE ROAD, WARWICK, RI, 02886, USA
Purpose: PRACTICE OF MEDICINE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1669647012 2008-04-28 2008-06-23 215 TOLL GATE RD, SUITE 305, WARWICK, RI, 028864458, US 215 TOLL GATE RD, SUITE 305, WARWICK, RI, 028864458, US

Contacts
Phone +1 401-738-2601
Fax 4017382660

Authorized person
Name DR. RICHARD P. SAN ANTONIO
Role OWNER
Phone 4017382601

Taxonomy
Taxonomy Code 207RC0000X - Cardiovascular Disease Physician
Is Primary Yes

Other Provider Identifiers
Issuer MULTIPLAN
Number P12043590
Issuer AETNA
Number 0005592221
Issuer HARVARD/PILGRIM
Number AA39929
Issuer MEDICAID
Number 9000485
State RI
Issuer BLUECROSS
Number 000485
State RI
Issuer TUFTS
Number 006410
Issuer UNITED HEALTH
Number 2500217
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RICHARD P. SAN ANTONIO, M.D., FACC, INC. DEFINED BENEFIT PENSION PLAN 2017 050415620 2018-09-11 RICHARD P. SAN ANTONIO, M.D., FACC, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017382601
Plan sponsor’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415620
Plan administrator’s name RICHARD P. SAN ANTONIO,M.D.,INC.
Plan administrator’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886
Administrator’s telephone number 4017382601
RICHARD P. SAN ANTONIO, M.D., FACC, INC. DEFINED BENEFIT PENSION PLAN 2016 050415620 2017-10-08 RICHARD P. SAN ANTONIO, M.D., FACC, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017382601
Plan sponsor’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415620
Plan administrator’s name RICHARD P. SAN ANTONIO,M.D.,INC.
Plan administrator’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886
Administrator’s telephone number 4017382601
RICHARD P. SAN ANTONIO, M.D., FACC, INC. DEFINED BENEFIT PENSION PLAN 2015 050415620 2016-10-11 RICHARD P. SAN ANTONIO, M.D., FACC, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017382601
Plan sponsor’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415620
Plan administrator’s name RICHARD P. SAN ANTONIO,M.D.,INC.
Plan administrator’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886
Administrator’s telephone number 4017382601
RICHARD P. SAN ANTONIO, M.D., FACC, INC. DEFINED BENEFIT PENSION PLAN 2014 050415620 2015-10-13 RICHARD P. SAN ANTONIO, M.D., FACC, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017382601
Plan sponsor’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415620
Plan administrator’s name RICHARD P. SAN ANTONIO,M.D.,INC.
Plan administrator’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886
Administrator’s telephone number 4017382601

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing RICHARD P. SAN ANTONIO, MD
Valid signature Filed with authorized/valid electronic signature
RICHARD P. SAN ANTONIO, M.D., FACC, INC. DEFINED BENEFIT PENSION PLAN 2013 050415620 2014-09-25 RICHARD P. SAN ANTONIO, M.D., FACC, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017382601
Plan sponsor’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415620
Plan administrator’s name RICHARD P. SAN ANTONIO,M.D.,INC.
Plan administrator’s address 215 TOLL GATE ROAD #305, WARWICK, RI, 02886
Administrator’s telephone number 4017382601

Signature of
Role Plan administrator
Date 2014-09-25
Name of individual signing RICHARD P. SAN ANTONIO, MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JOHN S. DIBONA, ESQ. Agent 78 KENWOOD STREET, CRANSTON, RI, 02907, USA

PRESIDENT

Name Role Address
RICHARD P SAN ANTONIO PRESIDENT 215 TOLLGATE ROAD WARWICK, RI 02886 USA

Filings

Number Name File Date
202341447780 Revocation Certificate For Failure to File the Annual Report for the Year 2023-09-12
202337995710 Revocation Notice For Failure to File An Annual Report 2023-06-19
202212413810 Annual Report 2022-03-02
202190949930 Annual Report 2021-02-10
202038594500 Statement of Change of Registered Office by the Registered Agent 2020-04-23
202033687900 Annual Report 2020-02-03
201986849700 Annual Report 2019-02-15
201859027150 Annual Report 2018-02-22
201745032350 Statement of Change of Registered Office by the Registered Agent 2017-06-07
201734525270 Annual Report 2017-02-21

Related by officers

JOHN S. DIBONA, ESQ.

Premier One Implant Centers, Inc. BELL FINDINGS CO., INC. BELL-ROSE REALTY CO., INC. Beneficial Energy Products, Inc. CRANSTON BUSINESS MACHINES, INC. Fermac Realty, Inc. SVR, INC. MESHANTICUT VALLEY REAL ESTATE, INC. GENERALI BROTHERS, INC. E. M. S. DEVELOPMENT CORPORATION

Related by address

215 TOLLGATE ROAD, WARWICK, RI, 02886, USA

WILLIAM F. GARRAHAN, M.D., INC. Sudhir Bansal, M.D., Inc. GATE OCCUPATIONAL MEDICAL CENTER, INC. RALPH A. DIGIACOMO, M.D., P.C. GATE ORTHOPEDICS, INC. Gerald Exil, M.D., Inc. CHILD NEUROLOGY ASSOCIATES, LLC MJI, Inc. GI Associates Realty, LLC

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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