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  5. THOMAS R. LEDDY, M.D., LLC

THOMAS R. LEDDY, M.D., LLC

Company Details

Name: THOMAS R. LEDDY, M.D., LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Revoked Entity
Date of Organization in Rhode Island: 26 Jul 2005 (20 years ago)
Date of Dissolution: 17 Sep 2024 (4 months ago)
Date of Status Change: 17 Sep 2024 (4 months ago)
Identification Number: 000149524
ZIP code: 02886
County: Kent County
Principal Address: 390 TOLLGATE ROAD SUITE 107, WARWICK, RI, 02886, USA
Purpose: 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
1275575748 2006-06-11 2020-08-22 390 TOLL GATE RD, WARWICK, RI, 028864326, US 390 TOLL GATE RD, WARWICK, RI, 028864326, US

Contacts
Phone +1 401-732-2662
Fax 4017322669

Authorized person
Name DR. THOMAS RAYMOND LEDDY
Role OWNER
Phone 4017322662

Taxonomy
Taxonomy Code 207W00000X - Ophthalmology Physician
License Number MD04438
State RI
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CHIP COMMERCIAL
Number 001291
State RI
Issuer MEDICAID
Number 9000459
State RI
Issuer UNITED HEALTH
Number 08-00128
State RI
Issuer TUFTS
Number 004438
State RI
Issuer BLUE SHIELD
Number 459-4
State RI
Issuer MULTIPLAN
Number P-12018674
State RI
Issuer CIGNA
Number 0138733
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2017 050415470 2018-09-27 THOMAS R. LEDDY, M.D., LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2017 050415470 2018-05-30 THOMAS R. LEDDY, M.D., LLC 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2016 050415470 2017-04-01 THOMAS R. LEDDY, M.D., LLC 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2015 050415470 2016-05-23 THOMAS R. LEDDY, M.D., LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2014 050415470 2015-06-08 THOMAS R. LEDDY, M.D., LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2015-06-08
Name of individual signing THOMAS R. LEDDY, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2013 050415470 2014-04-22 THOMAS R. LEDDY, M.D., LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2014-04-22
Name of individual signing THOMAS R. LEDDY, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2012 050415470 2013-05-16 THOMAS R. LEDDY, M.D., LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415470
Plan administrator’s name THOMAS R. LEDDY, M.D., LLC
Plan administrator’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886
Administrator’s telephone number 4017322662

Signature of
Role Plan administrator
Date 2013-05-16
Name of individual signing THOMAS R. LEDDY, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2011 050415470 2012-05-02 THOMAS R. LEDDY, M.D., LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415470
Plan administrator’s name THOMAS R. LEDDY, M.D., LLC
Plan administrator’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886
Administrator’s telephone number 4017322662

Signature of
Role Plan administrator
Date 2012-05-02
Name of individual signing THOMAS R. LEDDY, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2010 050415470 2011-06-15 THOMAS R. LEDDY, M.D., LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415470
Plan administrator’s name THOMAS R. LEDDY, M.D., LLC
Plan administrator’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886
Administrator’s telephone number 4017322662

Signature of
Role Plan administrator
Date 2011-06-15
Name of individual signing THOMAS R. LEDDY, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS R. LEDDY, M.D., LLC PROFIT SHARING PLAN 2009 050415470 2010-06-24 THOMAS R. LEDDY, M.D., LLC 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1988-01-01
Business code 621399
Sponsor’s telephone number 4017322662
Plan sponsor’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050415470
Plan administrator’s name THOMAS R. LEDDY, M.D., LLC
Plan administrator’s address 390 TOLL GATE ROAD, WARWICK, RI, 02886
Administrator’s telephone number 4017322662

Signature of
Role Plan administrator
Date 2010-06-23
Name of individual signing THOMAS R. LEDDY, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
STEPHEN D. ZUBIAGO, ESQ. Agent NIXON PEABODY LLP ONE CITIZENS PLAZA SUITE 500, PROVIDENCE, RI, 02903, USA

Filings

Number Name File Date
202459666990 Revocation Certificate For Failure to File the Annual Report for the Year 2024-09-17
202456308820 Revocation Notice For Failure to File An Annual Report 2024-06-18
202332866330 Annual Report 2023-04-12
202215556730 Annual Report 2022-04-21
202104959310 Annual Report 2021-11-08
202075324720 Annual Report 2020-11-16
201925211650 Annual Report 2019-10-23
201879587270 Annual Report 2018-10-15
201753152750 Annual Report 2017-11-08
201612039910 Annual Report 2016-11-14

Related by officers

STEPHEN D. ZUBIAGO, ESQ.

Nicholas A. Califano, M.D., Inc. CARDIOLOGY ASSOCIATES, INC. MIRIAM IPA, INC. ORTHOPEDIC GROUP, INC. Bayside Endoscopy Group, Inc. Mobile Storage Inc. H & H TRUCKING INC. MIRIAM PHO, INC. Bayside OB-GYN, Inc. West Bay Orthopaedics and Neurosurgery, 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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