| Name: | South County Primary Care, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 24 Aug 2000 (24 years ago) |
| Identification Number: | 000114109 |
| ZIP code: | 02882 |
| County: | Washington County |
| Principal Address: | 360 KINGSTOWN ROAD STE 104, NARRAGANSETT, RI, 02882, USA |
| Purpose: | TO ENGAGE IN THE PRACTICE OF MEDICINE |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Fictitious names: |
South County Walk-In and Primary Care, Inc. (trading name, 2000-10-02 - ) |
| Historical names: |
Hanson and Gross, Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306816251 | 2006-01-24 | 2018-06-20 | 360 KINGSTOWN RD, SUITE 104, NARRAGANSETT, RI, 028823239, US | 360 KINGSTOWN RD, SUITE 104, NARRAGANSETT, RI, 028823239, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 401-789-1086 |
| Fax | 4017895344 |
Authorized person
| Name | DR. MONICA LOUISE GROSS |
| Role | OWNER |
| Phone | 4017891086 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | MD09154 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUECHIP |
| Number | 407659 |
| State | RI |
| Issuer | MEDICAID |
| Number | 9000328 |
| State | RI |
| Issuer | NHPRI |
| Number | 1962 |
| State | RI |
| Issuer | BCBS |
| Number | 22374-2 |
| Issuer | UNITED HEALTH PLAN |
| Number | 44-00013 |
| Issuer | NHP |
| Number | 2464 |
| State | RI |
| Issuer | HEALTH PARTNERS |
| Number | 111745 |
| Name | Role | Address |
|---|---|---|
| STEPHEN D. ZUBIAGO, ESQ. | Agent | NIXON PEABODY LLP ONE CITIZENS PLAZA SUITE 500, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| MONICA L GROSS MD | PRESIDENT | 360 KINGSTOWN ROAD NARRAGANSETT, RI 02882- USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2000-10-02 | Hanson and Gross, Inc. | South County Primary Care, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202449404270 | Annual Report | 2024-03-22 |
| 202335497180 | Annual Report | 2023-05-10 |
| 202216808270 | Annual Report | 2022-04-25 |
| 202194662790 | Annual Report | 2021-03-17 |
| 202035670810 | Annual Report | 2020-02-28 |
| 201989678190 | Annual Report | 2019-04-01 |
| 201859869480 | Annual Report | 2018-03-07 |
| 201738398690 | Annual Report | 2017-03-22 |
| 201692589880 | Annual Report | 2016-02-16 |
| 201558222900 | Annual Report | 2015-03-30 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
