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  5. OCEAN STATE PRIMARY CARE, LLC

OCEAN STATE PRIMARY CARE, LLC

Company Details

Name: OCEAN STATE PRIMARY CARE, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Activ
Date of Organization in Rhode Island: 13 Oct 2005 (19 years ago)
Identification Number: 000151208
ZIP code: 02886
County: Kent County
Principal Address: 300 TOLLGATE ROAD SUITE 202, WARWICK, RI, 02886, USA
Purpose: MEDICAL SERVICES PROVIDER
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1548332257 2006-11-15 2021-07-22 300 TOLL GATE RD STE 202, WARWICK, RI, 028864447, US 300 TOLL GATE RD STE 202, WARWICK, RI, 028864447, US

Contacts
Phone +1 401-739-4350
Fax 4017393759

Authorized person
Name FARHAT IBRAHIM
Role MD
Phone 4017394350

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number MD10008
State RI
Is Primary Yes

Other Provider Identifiers
Issuer B CHIP
Number 404939
Issuer BCBS
Number 309562
Issuer TUFTS
Number 400337
Issuer MEDICAID
Number 9004697
State RI
Issuer NHP
Number 2499

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
OSPC 401(K) PLAN 2023 203578572 2024-05-07 OCEAN STATE PRIMARY CARE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 300 TOLLGATE ROAD, SUITE 202, WARWICK, RI, 02886
OSPC 401(K) PLAN 2022 203578572 2023-05-02 OCEAN STATE PRIMARY CARE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 300 TOLLGATE ROAD, SUITE 202, WARWICK, RI, 02886
OSPC 401(K) PLAN 2021 203578572 2022-09-21 OCEAN STATE PRIMARY CARE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 300 TOLLGATE ROAD, SUITE 202, WARWICK, RI, 02886
OSPC 401(K) PLAN 2020 203578572 2021-05-20 OCEAN STATE PRIMARY CARE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 176 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886
OSPC 401(K) PLAN 2019 203578572 2020-06-22 OCEAN STATE PRIMARY CARE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 176 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886
OSPC 401(K) PLAN 2018 203578572 2019-09-27 OCEAN STATE PRIMARY CARE, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 176 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886
OSPC 401(K) PLAN 2017 203578572 2018-09-11 OCEAN STATE PRIMARY CARE, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 176 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886
OSPC 401(K) PLAN 2016 203578572 2017-10-16 OCEAN STATE PRIMARY CARE, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 176 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886
OSPC 401(K)PLAN 2015 203578572 2016-07-22 OCEAN STATE PRIMARY CARE, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 176 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2016-07-22
Name of individual signing FARHAT IBRAHIM
Valid signature Filed with authorized/valid electronic signature
OSPC 401(K)PLAN 2014 203578572 2015-10-07 OCEAN STATE PRIMARY CARE, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 176 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2015-10-07
Name of individual signing FARHAT IBRAHIM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/01/20141001144908P040010353503001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 176 TOLL GATE ROAD, SUITE 203, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2014-10-01
Name of individual signing FARHAT IBRAHIM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/09/20131009151316P030013103301001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 470 TOLL GATE ROAD, SUITE 105, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2013-10-09
Name of individual signing FARHAT IBRAHIM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/24/20120724104138P040033009232001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 470 TOLL GATE ROAD, STE 105, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 203578572
Plan administrator’s name OCEAN STATE PRIMARY CARE, LLC
Plan administrator’s address 470 TOLL GATE ROAD, STE 105, WARWICK, RI, 02886
Administrator’s telephone number 4017394350

Signature of
Role Plan administrator
Date 2012-07-24
Name of individual signing FARHAT IBRAHIM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/15/20110615114747P030076474145001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 470 TOLL GATE ROAD, STE 105, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 203578572
Plan administrator’s name OCEAN STATE PRIMARY CARE, LLC
Plan administrator’s address 470 TOLL GATE ROAD, STE 105, WARWICK, RI, 02886
Administrator’s telephone number 4017394350

Signature of
Role Plan administrator
Date 2011-06-15
Name of individual signing FARHAT IBRAHIM
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 470 TOLL GATE ROAD, STE 105, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 203578572
Plan administrator’s name OCEAN STATE PRIMARY CARE, LLC
Plan administrator’s address 470 TOLL GATE ROAD, STE 105, WARWICK, RI, 02886
Administrator’s telephone number 4017394350

Signature of
Role Plan administrator
Date 2010-09-21
Name of individual signing FARHAT IBRAHIM
Valid signature Filed with incorrect/unrecognized electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/27/20100927133749P030006817122001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4017394350
Plan sponsor’s address 470 TOLL GATE ROAD, STE 105, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 203578572
Plan administrator’s name OCEAN STATE PRIMARY CARE, LLC
Plan administrator’s address 470 TOLL GATE ROAD, STE 105, WARWICK, RI, 02886
Administrator’s telephone number 4017394350

Signature of
Role Plan administrator
Date 2010-09-27
Name of individual signing FARHAT IBRAHIM
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ANTHONY F. AMALFETANO, ESQ. Agent 140 COWESETT GREEN DRIVE, WARWICK, RI, 02886, USA

Filings

Number Name File Date
202455273020 Annual Report 2024-05-31
202333084300 Annual Report 2023-04-14
202212842980 Annual Report 2022-03-14
202103773980 Annual Report 2021-10-21
202197367890 Statement of Change of Registered/Resident Agent Office 2021-06-01
202066291060 Annual Report 2020-10-15
201922665690 Annual Report 2019-10-03
201877850330 Annual Report 2018-09-19
201750437940 Annual Report 2017-09-25
201610707910 Annual Report 2016-10-20

Related by officers

ANTHONY F. AMALFETANO, ESQ.

Louise F. Amalfetano, C.R.N.A., Ltd. Brady's Liquor, Inc. 1230 Partners, LLC RMD Realty, LLC CHILDREN'S CHOICE PEDIATRICS, LLC D. R. Creta, Jr. Corporation POST ROAD REALTY, LLC Bayberry Realty, LLC

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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