| Name: | Michael W. Lucarelli, D.O., Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 27 Mar 2000 (25 years ago) |
| Date of Dissolution: | 10 Dec 2019 (5 years ago) |
| Date of Status Change: | 10 Dec 2019 (5 years ago) |
| Identification Number: | 000111679 |
| ZIP code: | 02818 |
| County: | Kent County |
| Principal Address: | 688 FRENCHTOWN ROAD SUITE 1, EAST GREENWICH, RI, 02818, USA |
| Purpose: | THE PROVISION OF PROFESSIONAL MEDICAL SERVICES |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699909747 | 2009-05-04 | 2009-05-04 | 3461 S COUNTY TRL, SUITE 201, EAST GREENWICH, RI, 028181463, US | 3461 S COUNTY TRL, SUITE 201, EAST GREENWICH, RI, 028181463, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 401-471-6850 |
| Fax | 4014716855 |
Authorized person
| Name | DR. MICHAEL WILLIAM LUCARELLI |
| Role | PHYSICIAN/PRESIDENT |
| Phone | 4014716850 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | DO00491 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 089002947 |
| Name | Role | Address |
|---|---|---|
| MICHAEL W. LUCARELLI, D.O. | Agent | 688 FRENCHTOWN ROAD SUITE 1, EAST GREENWICH, RI, 02818, USA |
| Name | Role | Address |
|---|---|---|
| MICHAEL W LUCARELLI, D.O. | PRESIDENT | 688 FRENCHTOWN ROAD, SUITE 1 EAST GREENWICH, RI 02818 USA |
| Number | Name | File Date |
|---|---|---|
| 201929687730 | Articles of Dissolution | 2019-12-10 |
| 201929687000 | Statement of Change of Registered/Resident Agent | 2019-12-10 |
| 201929683840 | Annual Report | 2019-12-10 |
| 201929683390 | Reinstatement | 2019-12-10 |
| 201927726800 | Agent Resigned | 2019-11-18 |
| 201924572040 | Revocation Certificate For Failure to File the Annual Report for the Year | 2019-10-18 |
| 201907023590 | Revocation Notice For Failure to File An Annual Report | 2019-07-24 |
| 201858675550 | Statement of Change of Registered/Resident Agent | 2018-02-20 |
| 201855577640 | Annual Report | 2018-01-03 |
| 201730573400 | Annual Report | 2017-01-23 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
