| Name: | Providence Surgical Care Group, Incorporated |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 06 Dec 1999 (25 years ago) |
| Identification Number: | 000109539 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 486 SILVER SPRING ST, PROVIDENCE, RI, 02904-1556, USA |
| Purpose: | TO ENGAGE IN THE PRACTICE OF PROVIDING MEDICAL AND SURGICAL SERVICES. |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437232543 | 2006-10-23 | 2011-12-23 | 486 SILVER SPRING ST, PROVIDENCE, RI, 029041556, US | 486 SILVER SPRING ST, PROVIDENCE, RI, 029041556, US | |||||||||||||||||||||||||
|
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| Phone | +1 401-454-0690 |
| Fax | 4014544281 |
Authorized person
| Name | MR. ROBERT B PATTERSON |
| Role | PRESIDENT |
| Phone | 4014540690 |
Taxonomy
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PS32025 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| ROBERT PATTERSON, MD | Agent | 486 SILVER SPRING STREET, PROVIDENCE, RI, 02904, USA |
| Name | Role | Address |
|---|---|---|
| ROBERT B PATTERSON MD | TREASURER | 486 SILVER SPRING STREET PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| ROBERT B PATTERSON MD | SECRETARY | 486 SILVER SPRING STREET PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| ROBERT B PATTERSON MD | PRESIDENT | 486 SILVER SPRING STREET PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| ROBERT B PATTERSON MD | VICE PRESIDENT | 486 SILVER SPRING STREET PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| ROBERT B PATTERSON | OTHER OFFICER | 486 SILVER SPRING ST PROVIDENCE, RI 02904-1556 USA |
| Name | Role | Address |
|---|---|---|
| ROBERT B PATTERSON MD | DIRECTOR | 486 SILVER SPRING STREET PROVIDENCE, RI 02904 USA |
| Number | Name | File Date |
|---|---|---|
| 202445870970 | Annual Report | 2024-02-04 |
| 202327483490 | Annual Report | 2023-02-03 |
| 202218298150 | Annual Report | 2022-06-05 |
| 202185919210 | Annual Report | 2021-01-12 |
| 202033025090 | Annual Report | 2020-01-26 |
| 201985631630 | Annual Report | 2019-01-31 |
| 201860186060 | Annual Report | 2018-03-14 |
| 201750790450 | Annual Report | 2017-10-02 |
| 201747756380 | Revocation Notice For Failure to File An Annual Report | 2017-07-27 |
| 201589361960 | Annual Report | 2015-12-17 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
