| Name: | West Bay Surgical Associates, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 04 Nov 2004 (20 years ago) |
| Date of Dissolution: | 24 Oct 2017 (7 years ago) |
| Date of Status Change: | 24 Oct 2017 (7 years ago) |
| Identification Number: | 000143666 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 390 TOLL GATE ROAD, WARWICK, RI, 02886, USA |
| Purpose: | TO RENDER MEDICAL AND SURGICAL SERVICES |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174522304 | 2005-07-19 | 2022-07-21 | 390 TOLL GATE RD, STE.200, WARWICK, RI, 028864326, US | 390 TOLL GATE RD, STE.200, WARWICK, RI, 028864326, US | |||||||||||||||||||||||
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| Phone | +1 401-739-8010 |
| Fax | 4017396087 |
Authorized person
| Name | DR. CANDACE L. DYER |
| Role | PRESIDENT |
| Phone | 4017398010 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9003972 |
| State | PR |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WEST BAY SURGICAL ASSOCIATES INC ROTH SH 401-K PROFIT SHARING PLAN | 2015 | 201837671 | 2016-06-21 | WEST BAY SURGICAL ASSOCIATES INC | 7 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2016-06-21 |
| Name of individual signing | CANDACE DYER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| E. COLBY CAMERON, ESQ. | Agent | 301 PROMENADE STREET, PROVIDENCE, RI, 02908, USA |
| Name | Role | Address |
|---|---|---|
| JOHN ISAAC M.D. | PRESIDENT | 390 TOLLGATE ROAD WARWICK, RI 02886 USA |
| Number | Name | File Date |
|---|---|---|
| 201752141520 | Articles of Dissolution | 2017-10-24 |
| 201733985020 | Annual Report | 2017-02-13 |
| 201693537510 | Annual Report | 2016-03-01 |
| 201556772100 | Annual Report | 2015-03-09 |
| 201436321260 | Annual Report | 2014-02-26 |
| 201314328330 | Annual Report | 2013-03-22 |
| 201291325960 | Annual Report | 2012-03-22 |
| 201181384420 | Annual Report | 2011-08-04 |
| 201060280450 | Annual Report | 2010-03-15 |
| 200943836690 | Annual Report | 2009-03-12 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
