| Name: | W. JOHN ABADIER, M.D., LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 30 Dec 2005 (19 years ago) |
| Date of Dissolution: | 15 Jun 2009 (16 years ago) |
| Date of Status Change: | 15 Jun 2009 (16 years ago) |
| Identification Number: | 000152652 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 300 TOLL GATE ROAD, WARWICK, RI, 02886, USA |
| Purpose: | GENERAL PRACTICE OF MEDICINE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588836589 | 2008-03-31 | 2008-04-01 | 300 TOLL GATE RD, SUITE 305, WARWICK, RI, 028864416, US | 300 TOLL GATE RD, SUITE 305, WARWICK, RI, 028864416, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 401-738-6620 |
| Fax | 4017380013 |
Authorized person
| Name | DR. W. JOHN ABADIER |
| Role | OWNER |
| Phone | 4017386620 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | 5775 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | 5775 |
| State | RI |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9004705 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| DAVID E. REVENS | Agent | 946 CENTERVILLE ROAD, WARWICK, RI, 02886, USA |
| Number | Name | File Date |
|---|---|---|
| 200946492000 | Revocation Certificate For Failure to File the Annual Report for the Year | 2009-06-15 |
| 200944374380 | Revocation Notice For Failure to File An Annual Report | 2009-03-25 |
| 200805513420 | Annual Report | 2008-01-14 |
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
