| 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)This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| 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: 10 Apr 2025
Sources: Rhode Island Department of State
