| Name: | Coastal Medical, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 31 Mar 1995 (30 years ago) |
| Date of Dissolution: | 31 Aug 2024 (5 months ago) |
| Date of Status Change: | 31 Aug 2024 (5 months ago) |
| Identification Number: | 000083698 |
| ZIP code: | 02903 |
| County: | Providence County |
| Principal Address: | 10 DAVOL SQUARE SUITE 400, PROVIDENCE, RI, 02903, USA |
| Purpose: | TO PROVIDE PRIMARY CARE MEDICAL SERVICES TO PATIENTS REQUESTING SUCH SERVICES. |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Historical names: |
Rhode Island Primary Care, Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497897870 | 2007-02-13 | 2015-01-27 | 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA, 921211705, US | 65 SOCKANOSSET CROSS RD, SUITE 301, CRANSTON, RI, 029205536, US | |||||||||||||||||||
|
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| Phone | +1 858-625-2990 |
| Phone | +1 401-943-6910 |
Authorized person
| Name | KENNY HEINE |
| Role | VP OF OPERATIONS |
| Phone | 8586252990 |
Taxonomy
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| License Number | MD05719 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHRISTOPHER FERRARO | Agent | COASTAL MEDICAL INC. 10 DAVOL SQUARE SUITE 300, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| DAVID FRIED M.D. | PRESIDENT | 10 DAVOL SQUARE PROVIDENCE, RI 02903 USA |
| Name | Role | Address |
|---|---|---|
| ROBERT CICCHELLI M.D. | TREASURER | 10 DAVOL SQUARE, SUITE 300 PROVIDENCE, RI 02903 USA |
| Name | Role | Address |
|---|---|---|
| ROBERT CICCHELLI M.D. | SECRETARY | 10 DAVOL SQUARE, SUITE 300 PROVIDENCE, RI 02903 USA |
| Name | Role | Address |
|---|---|---|
| DAVID FRIED M.D. | CHAIR | 10 DAVOL SQUARE, SUITE 300 PROVIDENCE, RI 02903 USA |
| Name | Role | Address |
|---|---|---|
| MANOJ GARG D.O. | DIRECTOR | 10 DAVOL SQUARE, SUITE 300 PROVIDENCE, RI 02903 USA |
| RAYMOND ZARLENGO M.D. | DIRECTOR | 10 DAVOL SQUARE, SUITE 300 PROVIDENCE, RI 02903 USA |
| CRISTINA MITCHELL M.D. | DIRECTOR | 10 DAVOL SQUARE, SUITE 300 PROVIDENCE, RI 02903 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 1995-07-20 | Rhode Island Primary Care, Inc. | Coastal Medical, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202458754760 | Articles of Dissolution | 2024-08-13 |
| 202449036020 | Annual Report | 2024-03-21 |
| 202328095070 | Annual Report | 2023-02-10 |
| 202326880470 | Statement of Change of Registered/Resident Agent | 2023-01-30 |
| 202209147360 | Annual Report | 2022-02-02 |
| 202187115250 | Annual Report | 2021-01-19 |
| 202032355080 | Annual Report | 2020-01-15 |
| 201983971080 | Annual Report | 2019-01-08 |
| 201855806010 | Annual Report | 2018-01-08 |
| 201729687840 | Annual Report | 2017-01-09 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
