| Name: | Sports Medicine, Orthopaedics & Podiatry, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 17 Nov 2000 (24 years ago) |
| Identification Number: | 000115404 |
| ZIP code: | 02914 |
| County: | Providence County |
| Principal Address: | 400 MASSASOIT AVENUE SUITE 200, EAST PROVIDENCE, RI, 02914, USA |
| Purpose: | TO OPERATE AND MANAGE A MEDICAL OFFICE, TO PROVIDE AND RENDER MEDICAL SERVICES, TREATMENTS IN ORTHOPAEDIC SURGERY |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407034994 | 2008-02-06 | 2021-12-02 | 400 MASSASOIT AVE STE 201, EAST PROVIDENCE, RI, 029142020, US | 400 MASSASOIT AVENUE, SUITE 201, EAST PROVIDENCE, RI, 029142012, US | |||||||||||||||||||||
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| Phone | +1 401-383-7753 |
| Fax | 4013838982 |
Authorized person
| Name | DR. JACK D GOLDSTEIN |
| Role | PRESIDENT |
| Phone | 4013837753 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9020116 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| JACK GOLDSTEIN MD | Agent | 400 MASSOSOIT AVENUE SUITE 200, EAST PROVIDENCE, RI, 02914, USA |
| Name | Role | Address |
|---|---|---|
| JACK DANIEL GOLDSTEIN MD | PRESIDENT | 400 MASSASOIT AVE, SUITE 200 EAST PROVIDENCE, RI 02914 USA |
| Number | Name | File Date |
|---|---|---|
| 202458924000 | Annual Report | 2024-08-19 |
| 202457148740 | Revocation Notice For Failure to File An Annual Report | 2024-06-25 |
| 202326801330 | Annual Report | 2023-01-27 |
| 202217583040 | Annual Report | 2022-05-20 |
| 202185859660 | Annual Report | 2021-01-11 |
| 202031094250 | Annual Report | 2020-01-04 |
| 201912021480 | Annual Report | 2019-08-12 |
| 201907026780 | Revocation Notice For Failure to File An Annual Report | 2019-07-24 |
| 201861675770 | Statement of Change of Registered/Resident Agent Office | 2018-04-06 |
| 201861195160 | Annual Report | 2018-03-29 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
