| Name: | Santiago Medical Group, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 31 Jul 2002 (23 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 |
| Fictitious names: |
Mineral Spring Pediatrics, Inc. (trading name, 2009-03-05 - ) |
| Historical names: |
Mineral Spring Pediatrics, Inc. |
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 | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |||||||||||||
|
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| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8123977108 | 2020-04-15 | 0165 | PPP | 967 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 10 Apr 2025
Sources: Rhode Island Department of State
