| Name: | SOUTH COUNTY RADIATION THERAPY, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 08 Jan 2003 (22 years ago) |
| Date of Dissolution: | 06 Jan 2025 (3 months ago) |
| Date of Status Change: | 06 Jan 2025 (3 months ago) |
| Identification Number: | 000129193 |
| Principal Address: | 1419 SE 8TH TERRACE SUITE 200, CAPE CORAL, FL, 33990, USA |
| Purpose: | HEALTHCARE SERVICE PROVIDER |
NAICS
621498 All Other Outpatient Care CentersThis U.S. industry comprises establishments with medical staff primarily engaged in providing general or specialized outpatient care (except family planning centers, outpatient mental health and substance abuse centers, HMO medical centers, kidney dialysis centers, and freestanding ambulatory surgical and emergency centers). Centers or clinics of health practitioners with different degrees from more than one industry practicing within the same establishment (i.e., Doctor of Medicine and Doctor of Dental Medicine) are included in this industry. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841270303 | 2006-01-20 | 2019-07-12 | 2234 COLONIAL BLVD, FORT MYERS, FL, 339071412, US | 142 KENYON AVE, WAKEFIELD, RI, 028794216, US | |||||||||||||||||||||||||
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| Phone | +1 239-931-7342 |
| Fax | 2399317385 |
| Phone | +1 401-284-0850 |
| Fax | 4012840860 |
Authorized person
| Name | KIM COMMINS |
| Role | CEO |
| Phone | 2399317275 |
Taxonomy
| Taxonomy Code | 2085R0001X - Radiation Oncology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9004398 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY | Agent | 222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA |
| Name | Role | Address |
|---|---|---|
| TIMOTHY SHAFMAN MD | MANAGER | 2270 COLONIAL BOULEVARD FORT MYERS, FL 33907 USA |
| KIMBERLY O'CONNELL | MANAGER | 2270 COLONIAL BOULEVARD FORT MYERS, FL 33907 USA |
| THOMAS BREEN | MANAGER | 2270 COLONIAL BOULEVARD FORT MYERS, FL 33907 USA |
| K TODD HIGGINS | MANAGER | 2270 COLONIAL BOULEVARD FORT MYERS, FL 33907 USA |
| CHARLES POWELL | MANAGER | 2270 COLONIAL BOULEVARD FORT MYERS, FL 33907 USA |
| Number | Name | File Date |
|---|---|---|
| 202453362410 | Annual Report | 2024-04-30 |
| 202334565880 | Annual Report | 2023-04-28 |
| 202215435260 | Annual Report | 2022-04-21 |
| 202102672220 | Annual Report | 2021-10-05 |
| 202060007180 | Annual Report | 2020-10-01 |
| 201921831500 | Annual Report | 2019-09-30 |
| 201879024360 | Annual Report | 2018-10-08 |
| 201752473720 | Annual Report | 2017-10-30 |
| 201729439250 | Annual Report - Amended | 2017-01-04 |
| 201611266920 | Annual Report | 2016-10-27 |
Date of last update: 10 Apr 2025
Sources: Rhode Island Department of State
