| 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 (22 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 |
| Fictitious names: |
Broadway Medical Treatment Center (trading name, 2003-12-04 - ) |
NAICS
621111 Offices of Physicians (except Mental Health Specialists)This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5726988004 | 2020-06-29 | 0165 | PPP | 1053 S BROADWAY, EAST PROVIDENCE, RI, 02914-4729 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 11 Apr 2025
Sources: Rhode Island Department of State
