| Name: | Lewis R. Weiner, M.D., Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 01 Feb 2005 (20 years ago) |
| Identification Number: | 000145510 |
| ZIP code: | 02903 |
| County: | Providence County |
| Principal Address: | 1 DAVOL SQUARE SUITE 304, PROVIDENCE, RI, 02903, USA |
| Purpose: | TO PROVIDE MEDICAL SERVICES |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972721157 | 2007-04-23 | 2020-08-22 | 1 DAVOL SQ, #304, PROVIDENCE, RI, 029034755, US | 1 DAVOL SQ, #304, PROVIDENCE, RI, 029034755, US | |||||||||||||||||||||||||
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| Phone | +1 401-369-7070 |
| Fax | 4013697080 |
Authorized person
| Name | DR. LEWIS R. WEINER |
| Role | PRESIDENT |
| Phone | 4013697070 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | 07384 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9006564 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| LEWIS R. WEINER, M.D. | Agent | 1 RICHMOND SQUARE SUITE 210E, PROVIDENCE, RI, 02906, USA |
| Name | Role | Address |
|---|---|---|
| LEWIS R WEINER MD | PRESIDENT | 1 RHODE ISLAND AVE PROVIDENCE, RI 02906 US |
| Number | Name | File Date |
|---|---|---|
| 202453522300 | Statement of Change of Registered/Resident Agent Office | 2024-05-01 |
| 202453503020 | Annual Report | 2024-05-01 |
| 202333607220 | Annual Report | 2023-04-21 |
| 202333606520 | Annual Report | 2023-04-21 |
| 202208429160 | Annual Report | 2022-01-21 |
| 202195636150 | Annual Report | 2021-04-09 |
| 202063115080 | Annual Report | 2020-10-09 |
| 202055039350 | Revocation Notice For Failure to File An Annual Report | 2020-09-16 |
| 201990119310 | Annual Report | 2019-04-09 |
| 201862210790 | Annual Report | 2018-04-16 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
