| Name: | Peris Medical Corporation |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 30 Jan 2003 (22 years ago) |
| Date of Dissolution: | 17 Jun 2021 (4 years ago) |
| Date of Status Change: | 17 Jun 2021 (4 years ago) |
| Identification Number: | 000129700 |
| ZIP code: | 02907 |
| County: | Providence County |
| Principal Address: | 655 BROAD STREET 2ND FLOOR, PROVIDENCE, RI, 02907, USA |
| Purpose: | RENDERING PROFESSIONAL SERVICE AS A PHYSICIAN |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295952802 | 2007-04-18 | 2011-04-01 | 655 BROAD STREET, SUITE 201, PROVIDENCE, RI, 029071510, US | 655 BROAD STREET, SUITE 201, PROVIDENCE, RI, 029071510, US | |||||||||||||||||||||||
|
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| Phone | +1 401-383-6748 |
Authorized person
| Name | DR. EMILIO RODRIGUEZ-PERIS |
| Role | PROPIETOR |
| Phone | 4012266248 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | MD10391 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | ER48067 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| EMILIO RODRIGUEZ-PERIS | Agent | 655 BROAD STREET 2ND FLOOR, PROVIDENCE, RI, 02907, USA |
| Name | Role | Address |
|---|---|---|
| EMILIO RODRIGUEZ-PERIS | PRESIDENT | 655 BROAD STREET 2ND FLOOR PROVIDENCE, RI 02907 USA |
| Number | Name | File Date |
|---|---|---|
| 202198399340 | Articles of Dissolution | 2021-06-17 |
| 202190156950 | Annual Report | 2021-02-04 |
| 202035462550 | Annual Report | 2020-02-26 |
| 201988718860 | Annual Report | 2019-03-15 |
| 201988692340 | Statement of Change of Registered/Resident Agent | 2019-03-15 |
| 201859047680 | Annual Report | 2018-02-23 |
| 201730495630 | Annual Report | 2017-01-19 |
| 201690294560 | Annual Report | 2016-01-08 |
| 201553099200 | Annual Report | 2015-01-12 |
| 201433916180 | Annual Report | 2014-01-21 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
