| Name: | Family Internal Medicine, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 14 Mar 2006 (19 years ago) |
| Identification Number: | 000154317 |
| ZIP code: | 02864 |
| County: | Providence County |
| Principal Address: | 2295 DIAMOND HILL ROAD, CUMBERLAND, RI, 02864, USA |
| Purpose: | PHYSICIAN |
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 | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972514305 | 2006-08-10 | 2014-10-14 | 2295 DIAMOND HILL RD, CUMBERLAND, RI, 02864, US | 2295 DIAMOND HILL RD, CUMBERLAND, RI, 02864, US | |||||||||||||||||||||||||||||||
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| Phone | +1 401-333-3445 |
| Fax | 4013333465 |
Authorized person
| Name | MRS. PAULINE KHABBAZ |
| Role | OFFICE MANAGER |
| Phone | 4013333445 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 10573 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9004563 |
| State | RI |
| Issuer | BLUE CROSS |
| Number | 310521 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| JAMES A. BRIDEN | Agent | 17 HOLLOW RIDGE ROAD, RUMFORD, RI, 02916, USA |
| Name | Role | Address |
|---|---|---|
| BASSAM KHABBAZ MD | PRESIDENT | 2295 DIAMOND HILL ROAD CUMBERLAND, RI 02864- USA |
| Number | Name | File Date |
|---|---|---|
| 202446737560 | Annual Report | 2024-02-14 |
| 202340398920 | Statement of Change of Registered Office by the Registered Agent | 2023-08-17 |
| 202329124580 | Annual Report | 2023-02-21 |
| 202214774810 | Annual Report | 2022-04-08 |
| 202192088330 | Annual Report | 2021-02-17 |
| 202035430720 | Annual Report | 2020-02-24 |
| 201988924180 | Annual Report | 2019-03-18 |
| 201859170630 | Annual Report | 2018-02-23 |
| 201731043470 | Annual Report | 2017-01-27 |
| 201692132860 | Annual Report | 2016-02-08 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5029277709 | 2020-05-01 | 0165 | PPP | 2295 DIAMOND HILL RD, CUMBERLAND, RI, 02864-5104 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
