| Name: | Family Doctors of East Providence, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 11 May 1999 (26 years ago) |
| Date of Dissolution: | 28 Aug 2013 (11 years ago) |
| Date of Status Change: | 28 Aug 2013 (11 years ago) |
| Identification Number: | 000106403 |
| ZIP code: | 02915 |
| County: | Providence County |
| Principal Address: | 1445 WAMPANOAG TRAIL SUITE 205, EAST PROVIDENCE, RI, 02915, USA |
| Purpose: | TO PROVIDE FAMILY HEALTH CARE TO PATIENTS. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245267509 | 2006-06-26 | 2020-08-22 | 1445 WAMPANOAG TRL, UNIT 205, RIVERSIDE, RI, 029151000, US | 1445 WAMPANOAG TRL, UNIT 205, RIVERSIDE, RI, 029151000, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 401-434-0770 |
| Fax | 4016336094 |
Authorized person
| Name | DR. JAMES M. SCHWARTZ |
| Role | PRESIDENT |
| Phone | 4014340770 |
Taxonomy
| Taxonomy Code | 173000000X - Legal Medicine |
| License Number | RI9206 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 7004039 |
| State | RI |
| Issuer | MEDICAID |
| Number | 7005523 |
| State | RI |
| Issuer | MEDICAID |
| Number | JA24654 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| DON E. WINEBERG, ESQ. | Agent | ONE PARK ROW SUITE 300, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| JOYCE A. ALVES | VICE PRESIDENT | 1445 WAMPANOAG TRAIL #205 EAST PROVIDENCE, RI 02915 USA |
| MARGARET A, SUN | VICE PRESIDENT | 1445 WAMPANOAG TRAIL #205 EAST PROVIDENCE, RI 02915 USA |
| MARGARET A SUN M.D. | VICE PRESIDENT | 1445 WAMPANOAG TRAIL, UNIT 205 EAST PROVIDENCE, RI 02915 USA |
| Name | Role | Address |
|---|---|---|
| JAMES SCHWARTZ MD | PRESIDENT | 1445 WAMPANOAG TRAIL, SUITE 205 EAST PROVIDENCE, RI 02914 USA |
| Number | Name | File Date |
|---|---|---|
| 201327271630 | Revocation Certificate For Failure to File the Annual Report for the Year | 2013-08-28 |
| 201321864180 | Revocation Notice For Failure to File An Annual Report | 2013-06-03 |
| 201287538420 | Annual Report | 2012-01-04 |
| 201173050740 | Annual Report | 2011-01-03 |
| 200955744800 | Annual Report | 2009-12-31 |
| 200939936360 | Annual Report | 2009-01-06 |
| 200806619590 | Annual Report | 2008-02-08 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
