| 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) |
| 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 | |||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||
| 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 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
