| Name: | Kardous Primary Care, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 29 Oct 2003 (21 years ago) |
| Identification Number: | 000135722 |
| ZIP code: | 02920 |
| County: | Providence County |
| Principal Address: | 1145 RESERVOIR AVENUE SUITE 301, CRANSTON, RI, 02920, USA |
| Purpose: | RENDERING PROFESSIONAL SERVICES AS A PHYSICIAN |
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 | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134102841 | 2005-11-28 | 2018-05-16 | 1145 RESERVOIR AVE, STE 301, CRANSTON, RI, 029206055, US | 1145 RESERVOIR AVE, STE 301, CRANSTON, RI, 02920, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-946-5001 |
| Fax | 4019465101 |
Authorized person
| Name | ANTIOAN KARDOUS |
| Role | PRESIDENT |
| Phone | 4019465001 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 10089 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CHIP |
| Number | 408195 |
| State | RI |
| Issuer | RAILROAD MEDICARE |
| Number | DB0254 |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 272209 |
| State | RI |
| Issuer | MEDICAID |
| Number | 9003208 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| ANTIOAN KARDOUS | Agent | 1145 RESERVOIR AVENUE SUITE 301, CRANSTON, RI, 02920, USA |
| Name | Role | Address |
|---|---|---|
| ANTIOAN KARDOUS | PRESIDENT | 1145 RESERVOIR AVENUE, SUITE 301 CRANSTON, RI 02920 USA |
| Number | Name | File Date |
|---|---|---|
| 202448317120 | Annual Report | 2024-03-08 |
| 202330309730 | Annual Report | 2023-03-08 |
| 202213128560 | Annual Report | 2022-03-14 |
| 202192135070 | Annual Report | 2021-02-19 |
| 202035461940 | Annual Report | 2020-02-26 |
| 201988710990 | Annual Report | 2019-03-15 |
| 201859046700 | Annual Report | 2018-02-23 |
| 201730784130 | Annual Report | 2017-01-25 |
| 201690329000 | Annual Report | 2016-01-11 |
| 201554102530 | Annual Report | 2015-01-23 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 9311207701 | 2020-05-01 | 0165 | PPP | 1145 Reservoir Avenue 301, cranston, RI, 02920 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 11 Apr 2025
Sources: Rhode Island Department of State
