| Name: | South County Cardiology Associates, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 07 Feb 1990 (35 years ago) |
| Date of Dissolution: | 20 Jan 2015 (10 years ago) |
| Date of Status Change: | 20 Jan 2015 (10 years ago) |
| Identification Number: | 000059291 |
| ZIP code: | 02879 |
| County: | Washington County |
| Principal Address: | 70 KENYON AVENUE, WAKEFIELD, RI, 02879, USA |
| Purpose: | MEDICAL PRACTICE IN CARDIOLOGY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891895090 | 2006-09-25 | 2020-08-22 | 426 SCRABBLETOWN RD, SUITE F, NORTH KINGSTOWN, RI, 028523649, US | 426 SCRABBLETOWN RD, SUITE F, NORTH KINGSTOWN, RI, 028523649, US | |||||||||||||||||||||
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| Phone | +1 401-294-5831 |
| Fax | 4012947291 |
Authorized person
| Name | LISA M POISSON |
| Role | PRACTICE ADMINISTRATOR |
| Phone | 4012945831 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 7001692 |
| State | RI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SOUTH COUNTY CARDIOLOGY ASSOCIATES, INC. 401(K)PROFIT SHARING PLAN | 2009 | 050452097 | 2010-10-15 | SOUTH COUNTY CARDIOLOGY ASSOCIATES | 31 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 050452097 |
| Plan administrator’s name | SOUTH COUNTY CARDIOLOGY ASSOCIATES |
| Plan administrator’s address | 426 SCRABBLETOWN ROAD, NORTH KINGSTOWN, RI, 02852 |
| Administrator’s telephone number | 4017895770 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-15 |
| Name of individual signing | DAVID BADER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| RICAHRD B. CARPENTER | Agent | 20 MAIN STREET P.O. BOX 903, NORTH KINGSTOWN, RI, 02852, USA |
| Name | Role | Address |
|---|---|---|
| DAVID BADER | PRESIDENT | 70 KENYON AVE WAKEFIELD, RI 02879 USA |
| Name | Role | Address |
|---|---|---|
| DAVID BADER | TREASURER | 70 KENYON AVE WAKEFIELD, RI 02879 USA |
| Name | Role | Address |
|---|---|---|
| DAVID BROZA | SECRETARY | 70 KENYON AVE WAKEFIELD, RI 02879 USA |
| Name | Role | Address |
|---|---|---|
| NEIL BRANDON | VICE PRESIDENT | 70 KENYON AVE WAKEFIELD, RI 02879 USA |
| Number | Name | File Date |
|---|---|---|
| 201553929930 | Articles of Dissolution | 2015-01-20 |
| 201447120580 | Annual Report | 2014-10-03 |
| 201439411300 | Revocation Notice For Failure to File An Annual Report | 2014-05-20 |
| 201307494350 | Annual Report | 2013-01-07 |
| 201289724290 | Annual Report | 2012-02-16 |
| 201173097880 | Annual Report | 2011-01-04 |
| 201060150140 | Annual Report | 2010-03-11 |
| 201058732440 | Statement of Change of Registered Office by the Registered Agent | 2010-02-21 |
| 200943277330 | Annual Report | 2009-02-26 |
| 200806345020 | Annual Report | 2008-01-31 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
