| Name: | Santiago Medical Group, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 31 Jul 2002 (22 years ago) |
| Identification Number: | 000126207 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 967 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904, USA |
| Purpose: | THE PRACTICE OF MEDICINE AND OTHER LAWFUL BUSINESS |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Fictitious names: |
Mineral Spring Pediatrics, Inc. (trading name, 2009-03-05 - ) |
| Historical names: |
Mineral Spring Pediatrics, Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790830339 | 2007-01-24 | 2009-07-15 | 967 MINERAL SPRING AVE, NORTH PROVIDENCE, RI, 029044934, US | 967 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 029044934, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 401-312-0444 |
Authorized person
| Name | DR. MIGUEL A FUENTES |
| Role | PRESIDENT |
| Phone | 4013120444 |
Taxonomy
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| IGLIOZZI & REIS, LLP | Agent | 926 PARK AVENUE, CRANSTON, RI, 02910, USA |
| Name | Role | Address |
|---|---|---|
| MIGUEL FUENTES MD | PRESIDENT | 982 MINERAL SPRING AVENUE NORTH PROVIDENCE, RI 02904 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2009-03-05 | Mineral Spring Pediatrics, Inc. | Santiago Medical Group, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202454462010 | Annual Report | 2024-05-01 |
| 202333596380 | Annual Report | 2023-04-21 |
| 202215488770 | Annual Report | 2022-04-15 |
| 202193830000 | Annual Report | 2021-03-10 |
| 202035512020 | Annual Report | 2020-02-27 |
| 201985845460 | Annual Report | 2019-01-31 |
| 201858304360 | Annual Report | 2018-02-13 |
| 201731337830 | Annual Report | 2017-02-02 |
| 201692321660 | Annual Report | 2016-02-11 |
| 201554056860 | Annual Report | 2015-01-22 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
