| Name: | LINCOLN PEDIATRIC ASSOC., INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 29 Jan 1991 (34 years ago) |
| Identification Number: | 000063248 |
| ZIP code: | 02865 |
| County: | Providence County |
| Principal Address: | 6 BLACKSTONE VALLEY PLACE, LINCOLN, RI, 02865, USA |
| Purpose: | MEDICAL OFFICE |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588648935 | 2005-11-30 | 2020-08-22 | 6 BLACKSTONE VALLY PLACE, SUITE 306B, LINCOLN, RI, 02865, US | 6 BLACKSTONE VALLY PLACE, SUITE 306B, LINCOLN, RI, 02865, US | |||||||||||||||||||||||||
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| Phone | +1 401-331-4021 |
| Fax | 4013344886 |
Authorized person
| Name | DR. MARTA S SOWA |
| Role | VICE PRESIDENT OWNER |
| Phone | 4013344021 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | 6923 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 7003409 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| JEFFREY D. SOWA | Agent | 78 KENWOOD STREET, CRANSTON, RI, 02907, USA |
| Name | Role | Address |
|---|---|---|
| MARTA S. SOWA | PRESIDENT | 64 CHANNEL VIEW #3 WARWICK, RI 02889 USA |
| Name | Role | Address |
|---|---|---|
| MARTA S. SOWA | TREASURER | 64 CHANNEL VIEW #3 WARWICK, RI 02889 USA |
| Name | Role | Address |
|---|---|---|
| THOMAS P HINES | SECRETARY | 50 STRATHMORE ROAD CRANSTON, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| THOMAS P HINES | VICE PRESIDENT | 50 STRATHMORE ROAD CRANSTON, RI 02905 USA |
| Number | Name | File Date |
|---|---|---|
| 202453764340 | Annual Report | 2024-05-02 |
| 202332467140 | Annual Report | 2023-04-06 |
| 202213429720 | Annual Report | 2022-03-24 |
| 202194882260 | Annual Report | 2021-03-24 |
| 202190136240 | Statement of Change of Registered Office by the Registered Agent | 2021-02-05 |
| 202189923330 | Revocation Notice For Failure to Maintain a Registered Office | 2021-02-04 |
| 202189393700 | Registered Office Not Maintained | 2021-01-20 |
| 202037018430 | Annual Report | 2020-03-31 |
| 201989278390 | Annual Report | 2019-03-26 |
| 201861191180 | Annual Report | 2018-03-29 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
