| Name: | Jean Plover, M.D. Family Practice, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 01 Jul 2002 (23 years ago) |
| Date of Dissolution: | 12 Sep 2023 (2 years ago) |
| Date of Status Change: | 12 Sep 2023 (2 years ago) |
| Identification Number: | 000125650 |
| ZIP code: | 02905 |
| County: | Providence County |
| Principal Address: | 1660 BROAD STREET, CRANSTON, RI, 02905, USA |
| Purpose: | RENDERING PROFESSIONAL MEDICAL HEALTH CARE SERVICES |
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 | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619183407 | 2007-05-16 | 2012-12-20 | 1660 BROAD ST, CRANSTON, RI, 029052730, US | 1660 BROAD ST, CRANSTON, RI, 029052730, US | |||||||||||||||||||
|
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| Phone | +1 401-784-8281 |
| Fax | 4017848285 |
Authorized person
| Name | JEAN PLOVER |
| Role | PHYSICIAN OWNER |
| Phone | 4017848281 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | MD08149 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JEAN PLOVER MD | PRESIDENT | 1660 BROAD STREET CRANSTON, RI 02905- USA |
| Name | Role | Address |
|---|---|---|
| ALAN R. TATE ESQ. | Agent | 40 WESTMINSTER STREET, PROVIDENCE, RI, 02903, USA |
| Number | Name | File Date |
|---|---|---|
| 202341472250 | Revocation Certificate For Failure to File the Annual Report for the Year | 2023-09-12 |
| 202338058630 | Revocation Notice For Failure to File An Annual Report | 2023-06-19 |
| 202209330780 | Annual Report | 2022-02-03 |
| 202191697290 | Annual Report | 2021-02-17 |
| 202066953030 | Annual Report | 2020-10-21 |
| 202055021580 | Revocation Notice For Failure to File An Annual Report | 2020-09-16 |
| 201989251500 | Annual Report | 2019-03-26 |
| 201985751950 | Statement of Change of Registered Office by the Registered Agent | 2019-02-01 |
| 201860262890 | Annual Report | 2018-03-12 |
| 201738111370 | Annual Report | 2017-03-15 |
Date of last update: 10 Apr 2025
Sources: Rhode Island Department of State
