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Blackstone Valley OBGYN, Inc.

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Company Details

Name: Blackstone Valley OBGYN, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 27 Jan 1994 (31 years ago)
Date of Dissolution: 01 Mar 2021 (4 years ago)
Date of Status Change: 01 Mar 2021 (4 years ago)
Identification Number: 000075548
ZIP code: 02865
City: Lincoln
County: Providence County
Purpose: TO ENGAGE IN THE PRACTICE OF MEDICINE.
Fictitious names: Lincoln OBGYN (trading name, 1994-03-18 - )
Historical names: Jan J. Penkala M.D., Inc.
Principal Address: Google Maps Logo 6 BLACKSTONE PLACE SUITE 501, LINCOLN, RI, 02865, USA

Industry & Business Activity

NAICS

621111 Offices of Physicians (except Mental Health Specialists)

This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau

TREASURER

Name Role Address
JAN J PENKALA MD TREASURER 6 MERRILL LANE CUMBERLAND, RI 02864 USA

SECRETARY

Name Role Address
JAN J PENKALA MD SECRETARY 6 MERRILL LANE CUMBERLAND , RI 02864 USA

PRESIDENT

Name Role Address
JAN J PENKALA MD PRESIDENT 6 MERRILL LANE CUMBERLAND, RI 02864- USA

DIRECTOR

Name Role Address
JAN J PENKALA MD DIRECTOR 6 MERRILL LANE CUMBERLAND, RI 02864 USA

Agent

Name Role Address
HASLAW, INC. Agent 100 WESTMINSTER STREET SUITE 1500 C/O HINCKLEY ALLEN & SNYDER LLP, PROVIDENCE, RI, 02903, USA

National Provider Identifier

NPI Number:
1972632255

Authorized Person:

Name:
JAN J PENKALA
Role:
PHYSICIAN OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207V00000X - Obstetrics & Gynecology Physician
Is Primary:
Yes

Contacts:

Fax:
4013332454

Form 5500 Series

Employer Identification Number (EIN):
050476733
Plan Year:
2019
Number Of Participants:
4
Sponsor's telephone number:
Plan Administrator / Signatory:
JAN PENKALA(Plan administrator)
JAN PENKALA(Employer/plan sponsor)
Plan Year:
2019
Number Of Participants:
4
Sponsor's telephone number:
Plan Administrator / Signatory:
JAN PENKALA(Plan administrator)
JAN PENKALA(Employer/plan sponsor)
Plan Year:
2018
Number Of Participants:
5
Sponsor's telephone number:
Plan Administrator / Signatory:
JAN PENKALA(Plan administrator)
JAN PENKALA(Employer/plan sponsor)
Plan Year:
2017
Number Of Participants:
5
Sponsor's telephone number:
Plan Administrator / Signatory:
JAN PENKALA(Plan administrator)
Plan Year:
2017
Number Of Participants:
5
Sponsor's telephone number:
Plan Administrator / Signatory:
JAN PENKALA(Plan administrator)
JAN PENKALA(Employer/plan sponsor)

Events

Type Date Old Value New Value
Name Change 1994-03-18 Jan J. Penkala M.D., Inc. Blackstone Valley OBGYN, Inc.

Filings

Number Name File Date
202193334850 Articles of Dissolution 2021-03-01
202036842360 Annual Report 2020-03-26
201985299650 Annual Report 2019-01-28
201861133720 Annual Report 2018-03-28
201737996590 Annual Report 2017-03-14

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Date of last update: 09 Jul 2025

Sources: Rhode Island Department of State