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  5. Midland Medical, Inc.

Midland Medical, Inc.

Company Details

Name: Midland Medical, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 23 Dec 1988 (36 years ago)
Identification Number: 000053018
ZIP code: 02886
County: Kent County
Principal Address: 315 COMMONWEALTH AVENUE, WARWICK, RI, 02886, USA
Purpose: MEDICAL CENTER, URGENT CARE & PRIMARY CARE FACILITY
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)
Historical names: DRS. COLLINS & LEE, INC.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1407871270 2006-07-13 2008-05-02 1312 OAKLAWN AVE, CRANSTON, RI, 02920, US 1312 OAKLAWN AVE, CRANSTON, RI, 02920, US

Contacts
Phone +1 401-463-3380
Fax 4014633308

Authorized person
Name STEPHEN R BEAUPRE
Role MEDICAL DIRECTOR
Phone 4014633380

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary No
Taxonomy Code 261QU0200X - Urgent Care Clinic/Center
State RI
Is Primary Yes
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
License Number 7006274
State RI
Is Primary No
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
License Number 1276020001
State RI
Is Primary No

Other Provider Identifiers
Issuer MEDICAID DME
Number 7006274
State RI
Issuer MEDICAID
Number 0000128
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2023 050443054 2024-09-27 MIDLAND MEDICAL, INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 315 COMMONWEALTH AVE, STE A, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2024-09-27
Name of individual signing CAROL PELOQUIN
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2022 050443054 2023-06-05 MIDLAND MEDICAL, INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 315 COMMONWEALTH AVE, STE A, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2023-06-05
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2021 050443054 2022-05-25 MIDLAND MEDICAL, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 315 COMMONWEALTH AVE, STE A, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2022-05-25
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2020 050443054 2021-06-20 MIDLAND MEDICAL, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 315 COMMONWEALTH AVE, STE A, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2021-06-20
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2019 050443054 2020-06-17 MIDLAND MEDICAL, INC. 19
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2020-06-17
Name of individual signing ALONG1942
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2019 050443054 2020-06-30 MIDLAND MEDICAL, INC. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2020-06-30
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2018 050443054 2019-06-20 MIDLAND MEDICAL, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2019-06-20
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2017 050443054 2018-06-12 MIDLAND MEDICAL, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2018-06-12
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2016 050443054 2017-05-16 MIDLAND MEDICAL, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2017-05-16
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
MIDLAND MEDICAL, INC. 401(K) PROFIT SHARING PLAN 2015 050443054 2016-06-09 MIDLAND MEDICAL, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2016-06-09
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/06/08/20150608140225P040042675713001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2015-06-08
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/03/20140603111213P040375774947001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2014-06-03
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/06/18/20130618110634P030259150403001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVE, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2013-06-18
Name of individual signing ANNA LONG
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/22/20120622074850P040005787172001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVENUE, CRANSTON, RI, 02920

Plan administrator’s name and address
Administrator’s EIN 050443054
Plan administrator’s name MIDLAND MEDICAL, INC.
Plan administrator’s address 1312 OAKLAWN AVENUE, CRANSTON, RI, 029202635
Administrator’s telephone number 4014633380

Signature of
Role Plan administrator
Date 2012-06-22
Name of individual signing STEPHEN BEAUPRE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/27/20110727124339P030101607041001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVENUE, CRANSTON, RI, 029202635

Plan administrator’s name and address
Administrator’s EIN 050443054
Plan administrator’s name MIDLAND MEDICAL, INC.
Plan administrator’s address 1312 OAKLAWN AVENUE, CRANSTON, RI, 029202635
Administrator’s telephone number 4014633380

Signature of
Role Plan administrator
Date 2011-07-27
Name of individual signing STEPHEN BEAUPRE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/26/20100726115925P040399080225001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4014633380
Plan sponsor’s address 1312 OAKLAWN AVENUE, CRANSTON, RI, 029202635

Plan administrator’s name and address
Administrator’s EIN 050443054
Plan administrator’s name MIDLAND MEDICAL, INC.
Plan administrator’s address 1312 OAKLAWN AVENUE, CRANSTON, RI, 029202635
Administrator’s telephone number 4014633380

Signature of
Role Plan administrator
Date 2010-07-26
Name of individual signing STEPHEN R. BEAUPRE, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JESSICA L. RATCLIFFE, CPA Agent 1990 PAWTUCKET AVENUE SUITE 1B, EAST PROVIDENCE, RI, 02914, USA

PRESIDENT

Name Role Address
STEPHEN R BEAUPRE PRESIDENT 38 JANE HOWLAND PLACE SEEKONK, MA 02771- USA

Events

Type Date Old Value New Value
Name Change 1997-03-31 DRS. COLLINS & LEE, INC. Midland Medical, Inc.

Filings

Number Name File Date
202453695130 Annual Report 2024-05-01
202334200330 Annual Report 2023-04-26
202217315100 Annual Report 2022-05-09
202214261400 Statement of Change of Registered Office by the Registered Agent 2022-04-07
202213530930 Revocation Notice For Failure to Maintain a Registered Office 2022-03-28
202213297040 Registered Office Not Maintained 2022-02-08
202194831330 Annual Report 2021-03-22
202033401290 Annual Report 2020-01-29
201914947300 Annual Report 2019-08-23
201914947120 Statement of Change of Registered/Resident Agent 2019-08-23

Related by officers

JESSICA L. RATCLIFFE, CPA

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Related by address

No related companies by address

Date of last update: 07 Oct 2024

Sources: Rhode Island Department of State

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