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  5. KINGSTOWN PEDIATRICS, INC.

KINGSTOWN PEDIATRICS, INC.

Company Details

Name: KINGSTOWN PEDIATRICS, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 01 Dec 2004 (20 years ago)
Identification Number: 000144307
ZIP code: 02852
County: Washington County
Principal Address: 426F SCRABBLETOWN RD, NORTH KINGSTOWN, RI, 02852, USA
Purpose: TO OWN AND OPERATE A PEDIATRIC MEDICAL PRACTICE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1912030792 2007-03-13 2013-06-21 420 SCRABBLETOWN RD STE A, NORTH KINGSTOWN, RI, 028523638, US 420 SCRABBLETOWN RD STE A, NORTH KINGSTOWN, RI, 028523638, US

Contacts
Phone +1 401-295-7400
Fax 4012957825

Authorized person
Name COLLEEN ANN POWERS
Role OWNER
Phone 4012957400

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
License Number RI09449
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 9004013
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2023 201840282 2024-07-23 KINGSTOWN PEDIATRICS INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2024-07-23
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-23
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2022 201840282 2023-08-15 KINGSTOWN PEDIATRICS INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2023-08-15
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-08-15
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2021 201840282 2022-07-12 KINGSTOWN PEDIATRICS INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2022-07-12
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-12
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2020 201840282 2021-08-10 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2021-08-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-08-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2019 201840282 2020-08-18 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2020-08-18
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-08-18
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2018 201840282 2019-05-08 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2019-05-08
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-08
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2017 201840282 2018-07-10 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2018-07-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2016 201840282 2017-09-25 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2017-09-25
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-25
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2015 201840282 2016-09-12 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2016-09-12
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-12
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2014 201840282 2015-08-19 KINGSTOWN PEDIATRICS INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2015-08-19
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-08-19
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/06/20141006092610P030011100527001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2014-10-06
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-06
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/09/10/20130910112854P030051582455001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2013-09-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/27/20120927160816P030004365973001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 201840282
Plan administrator’s name KINGSTOWN PEDIATRICS INC.
Plan administrator’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4012957400

Signature of
Role Plan administrator
Date 2012-09-27
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-27
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/21/20110721155455P040100715585001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 201840282
Plan administrator’s name KINGSTOWN PEDIATRICS INC.
Plan administrator’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4012957400

Signature of
Role Plan administrator
Date 2011-07-21
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-21
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MARTHA DAY Agent 27 OAK STREET, WAKEFIELD, RI, 02879, USA

TREASURER

Name Role Address
COLLEEN POWERS TREASURER 115 B WINCHESTER DRIVE WAKEFIELD, RI 02879 USA

SECRETARY

Name Role Address
COLLEEN POWERS SECRETARY 115 B WINCHESTER DRIVE WAKEFIELD, RI 02879 USA

PRESIDENT

Name Role Address
COLLEEN POWERS PRESIDENT 115 B WINCHESTER DRIVE WAKEFIELD, RI 02879- USA

DIRECTOR

Name Role Address
COLLEEN POWERS DIRECTOR 115 B WINCHESTER DRIVE WAKEFIELD, RI 02879 USA

Filings

Number Name File Date
202450539220 Annual Report 2024-04-09
202333184820 Annual Report 2023-04-18
202214058000 Annual Report 2022-04-06
202193239830 Annual Report 2021-02-28
202185838890 Statement of Change of Registered/Resident Agent Office 2021-01-11
202034698040 Annual Report 2020-02-19
201987803990 Annual Report 2019-02-28
201858086040 Annual Report 2018-02-12
201730972690 Annual Report 2017-01-27
201691550250 Annual Report 2016-02-01

Related by officers

MARTHA DAY

Brown Bear Holdings, Inc. Tidy-Up, Inc. AMERICAN HEALTH PRODUCTS, INC. CLARK FARMS, INC. FOUNDATION FOR MANAGEMENT EXCELLENCE SPAULDING ENVIRONMENTAL ASSOCIATES, INC. (SEA) OWEN TEGAN ASSOCIATES, INC. FOUNDATION FOR MANAGEMENT EDUCATION Premier Financial Services, Inc. A. M. MANAGEMENT, INC.

Related by address

No related companies by address

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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