| Name: | Primary Care Medical Associates of Cranston, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 27 May 2003 (22 years ago) |
| Identification Number: | 000132275 |
| ZIP code: | 02905 |
| County: | Providence County |
| Principal Address: | 1596 BROAD STREET, CRANSTON, RI, 02905, USA |
| Purpose: | TO OPERATE A MEDICAL OFFICE AND MEDICAL LABORATORY |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346307485 | 2007-01-01 | 2016-03-01 | 1596 BROAD ST, CRANSTON, RI, 029054130, US | 1596 BROAD ST, CRANSTON, RI, 029054130, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-461-5400 |
| Fax | 4014619039 |
Authorized person
| Name | DR. ELIZABETH G DEJESUS |
| Role | MEDICAL DIRECTOR |
| Phone | 4014615400 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 10197 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PC54016 |
| State | RI |
| Issuer | NEIGHBORHOOD HEALTH |
| Number | 2982 |
| State | RI |
| Issuer | TUFTS |
| Number | 469187 |
| State | RI |
| Issuer | ADVANTRA |
| Number | 759600 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| ELIZABETH G. DE JESUS | Agent | 1596 BROAD STREET, CRANSTON, RI, 02905, USA |
| Name | Role | Address |
|---|---|---|
| ELIZABETH DE JESUS | PRESIDENT | 1596 BROAD ST CRANSTON, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| BENILDE DA SILVA | SECRETARY | 2475 PAWTUCKET AVE EAST PROVIDENCE, RI 02910 USA |
| Number | Name | File Date |
|---|---|---|
| 202455180210 | Annual Report | 2024-05-31 |
| 202331222830 | Annual Report | 2023-03-21 |
| 202218055230 | Annual Report | 2022-05-31 |
| 202198175520 | Annual Report | 2021-06-11 |
| 202196817530 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
| 202035627580 | Annual Report | 2020-03-01 |
| 201988691000 | Annual Report | 2019-03-15 |
| 201859434110 | Annual Report | 2018-02-28 |
| 201734798980 | Annual Report | 2017-02-27 |
| 201693423930 | Annual Report | 2016-02-29 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
