| Name: | EMERGENCY MEDICINE PHYSICIANS OF PROVIDENCE COUNTY, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 18 Nov 2003 (21 years ago) |
| Date of Dissolution: | 14 Feb 2022 (3 years ago) |
| Date of Status Change: | 14 Feb 2022 (3 years ago) |
| Identification Number: | 000136152 |
| Principal Address: | 4535 DRESSLER ROAD NW, CANTON, OH, 44718, USA |
| Purpose: | EMERGENCY PHYSICIAN STAFFING |
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 | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194764019 | 2006-06-06 | 2007-10-23 | 4535 DRESSLER RD NW, CANTON, OH, 447182545, US | 825 CHALKSTONE AVE, PROVIDENCE, RI, 029084728, US | |||||||||||||||||||||
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| Phone | +1 330-493-4443 |
| Fax | 3304938677 |
Authorized person
| Name | DAVID C PACKO |
| Role | PRESIDENT |
| Phone | 3304934443 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9003126 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY | Agent | 222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA |
| Name | Role | Address |
|---|---|---|
| USACS MANAGEMENT GROUP, LTD | MANAGER | 4535 DRESSLER ROAD CANTON, OH 44718 USA |
| Number | Name | File Date |
|---|---|---|
| 202210220230 | Revocation Certificate For Failure to File the Annual Report for the Year | 2022-02-14 |
| 202106681930 | Revocation Notice For Failure to File An Annual Report | 2021-12-03 |
| 202067517330 | Annual Report | 2020-10-22 |
| 201925902710 | Annual Report | 2019-10-29 |
| 201876977650 | Annual Report | 2018-09-10 |
| 201750529050 | Annual Report | 2017-09-27 |
| 201608498570 | Annual Report | 2016-09-07 |
| 201604098530 | Statement of Change of Registered/Resident Agent | 2016-08-30 |
| 201576121740 | Annual Report | 2015-08-25 |
| 201444147490 | Annual Report | 2014-08-14 |
Date of last update: 11 Apr 2025
Sources: Rhode Island Department of State
