| 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)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 | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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
