| Name: | SMITH INTERNAL MEDICINE GROUP, LTD. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 13 Jan 2004 (21 years ago) |
| Date of Dissolution: | 08 Sep 2017 (7 years ago) |
| Date of Status Change: | 08 Sep 2017 (7 years ago) |
| Identification Number: | 000137223 |
| ZIP code: | 02865 |
| County: | Providence County |
| Principal Address: | 2 WAKE ROBIN ROAD SUITE 103, LINCOLN, RI, 02865, USA |
| Purpose: | TO PROVIDE A PROFESSIONAL SERVICE INCLUDING THE PRACTICE OF INTERNAL MEDICINE |
| NAICS: | 62 - Health Care and Social Assistance |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245261817 | 2006-07-05 | 2020-08-22 | 100 HIGHLAND AVE, SUITE 203, PROVIDENCE, RI, 029062740, US | 100 HIGHLAND AVE, SUITE 203, PROVIDENCE, RI, 029062740, US | |||||||||||||||||||||
|
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| Phone | +1 401-521-2002 |
| Fax | 4015210906 |
Authorized person
| Name | DR. JEAN F SMITH |
| Role | PRESIDENT CEO |
| Phone | 4015212002 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9004024 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| MARTIN P. SLEPKOW | Agent | 1481 WAMPANOAG TRAIL, EAST PROVIDENCE, RI, 02915, USA |
| Name | Role | Address |
|---|---|---|
| JEAN F. SMITH | PRESIDENT | 2 WAKE ROBIN ROAD, SUITE 103 LINCOLN, RI 02865 USA |
| Number | Name | File Date |
|---|---|---|
| 201749379460 | Articles of Dissolution | 2017-09-08 |
| 201735183640 | Annual Report | 2017-02-27 |
| 201699714050 | Annual Report | 2016-06-02 |
| 201699713170 | Statement of Change of Registered/Resident Agent | 2016-06-02 |
| 201696268060 | Revocation Notice For Failure to Maintain a Registered Agent | 2016-04-27 |
| 201692628390 | Agent Resigned | 2016-02-16 |
| 201557642970 | Annual Report | 2015-03-16 |
| 201436523150 | Annual Report | 2014-02-28 |
| 201311122120 | Annual Report | 2013-02-06 |
| 201288919570 | Annual Report | 2012-02-01 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
