| Name: | SOUTH COUNTY RADIATION THERAPY, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 08 Jan 2003 (22 years 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 Centers |
| 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: 09 Oct 2024
Sources: Rhode Island Department of State
