| 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) |
| 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 | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| 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 |
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
