| Name: | Landmark Physician Office Services |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 12 Jun 2006 (19 years ago) |
| Date of Dissolution: | 18 Feb 2015 (10 years ago) |
| Date of Status Change: | 18 Feb 2015 (10 years ago) |
| Identification Number: | 000156667 |
| ZIP code: | 02895 |
| County: | Providence County |
| Principal Address: | 115 CASS AVENUE, WOONSOCKET, RI, 02895, USA |
| Purpose: | IDENTIFY NEEDS FOR AND OPERATE PHYSICIAN PRACTICES WITHIN THE GEOGRAPHIC SERVICE AREA OF LANDMARK MEDICAL CENTER |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396778593 | 2006-07-09 | 2013-05-29 | PO BOX 845582, BOSTON, MA, 022845582, US | 219 CASS AVE, WOONSOCKET, RI, 028954741, US | |||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 401-769-4100 |
| Fax | 4017669575 |
Authorized person
| Name | RICHARD R CHAREST |
| Role | PRESIDENT & CEO |
| Phone | 4017694100 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 5623 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | No |
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | MD10296 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 2086X0206X - Surgical Oncology Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9005058 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| JONATHAN N. SAVAGE, ESQ. | Agent | SHECHTMAN HALPERIN SAVAGE LLP 1080 MAIN STREET, PAWTUCKET, RI, 02860, USA |
| Name | Role | Address |
|---|---|---|
| RICHARD CHAREST | PRESIDENT | 115 CASS AVENUE WOONSOCKET, RI 02895 USA |
| Name | Role | Address |
|---|---|---|
| RICHARD CHAREST | DIRECTOR | 115 CASS AVENUE WOONSOCKET, RI 02895- USA |
| Number | Name | File Date |
|---|---|---|
| 201555203920 | Revocation Certificate For Failure to File the Annual Report for the Year | 2015-02-18 |
| 201449710400 | Revocation Notice For Failure to File An Annual Report | 2014-11-06 |
| 201322710260 | Annual Report | 2013-06-11 |
| 201322707350 | Statement of Change of Registered/Resident Agent | 2013-06-11 |
| 201293954230 | Annual Report | 2012-06-13 |
| 201181916630 | Annual Report | 2011-09-06 |
| 201181918850 | Annual Report | 2011-09-06 |
| 201181918490 | Annual Report | 2011-09-06 |
| 201181918670 | Annual Report | 2011-09-06 |
| 201181918760 | Annual Report | 2011-09-06 |
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
