| Name: | BROADWAY MEDICAL TREATMENT CENTER, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 13 Aug 2003 (21 years ago) |
| Identification Number: | 000134153 |
| ZIP code: | 02914 |
| County: | Providence County |
| Principal Address: | 1053 SOUTH BROADWAY, EAST PROVIDENCE, RI, 02914, USA |
| Mailing Address: | 50 PARK ROW WEST SUITE 107, PROVIDENCE, RI, 02903, USA |
| Purpose: | MEDICAL TREATMENT CENTER |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Fictitious names: |
Broadway Medical Treatment Center (trading name, 2003-12-04 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104010032 | 2007-09-04 | 2007-09-04 | 1053 S BROADWAY, EAST PROVIDENCE, RI, 029144729, US | 1053 S BROADWAY, EAST PROVIDENCE, RI, 029144729, US | |||||||||||||||||||
|
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| Phone | +1 401-438-5551 |
| Fax | 4014387272 |
Authorized person
| Name | DR. PETER GEORGE BRASSARD |
| Role | PHYSICIAN / OWNER |
| Phone | 4014385551 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | CMD 06972 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| STEPHEN J. DIGIANFILIPPO, ESQ. | Agent | 50 PARK ROW WEST SUITE 107 C/O VIEIRA & DIGIANFILIPPO LTD, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| PETER G. BRASSARD MD | MANAGER | 35 BLUFF ROAD BARRINGTON, RI 02806 USA |
| Number | Name | File Date |
|---|---|---|
| 202452112890 | Annual Report | 2024-04-22 |
| 202452112700 | Statement of Change of Registered/Resident Agent Office | 2024-04-22 |
| 202329391090 | Annual Report | 2023-02-24 |
| 202214213580 | Annual Report | 2022-03-30 |
| 202103346940 | Annual Report | 2021-10-15 |
| 202065351530 | Annual Report | 2020-10-13 |
| 201924837860 | Annual Report | 2019-10-18 |
| 201880968570 | Annual Report | 2018-11-07 |
| 201751433680 | Annual Report | 2017-10-11 |
| 201609579890 | Annual Report | 2016-09-28 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
