| Name: | Partners in Obstetrics and Gynecology, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 19 Dec 2006 (18 years ago) |
| Identification Number: | 000160441 |
| ZIP code: | 02860 |
| County: | Providence County |
| Principal Address: | 333 SCHOOL STREET SUITE 200, PAWTUCKET, RI, 02860, USA |
| Purpose: | OBSTETRICS AND GYNECOLOGY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962440545 | 2006-06-03 | 2020-08-22 | 333 SCHOOL ST, SUITE 200, PAWTUCKET, RI, 028605334, US | 333 SCHOOL ST, SUITE 205, PAWTUCKET, RI, 028605334, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-724-0600 |
| Fax | 4017248306 |
Authorized person
| Name | DR. LISA R DOMAGALSKI |
| Role | PARTNER |
| Phone | 4017240600 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9002529 |
| State | RI |
| Issuer | AETNA |
| Number | 462648 |
| Issuer | NEIGHBORHOOD HEALTH |
| Number | 2020 |
| State | RI |
| Issuer | BLUE CROSS |
| Number | 2529 |
| State | RI |
| Issuer | TUFTS HEALTH |
| Number | 608658 |
| Name | Role | Address |
|---|---|---|
| SCOTT L. HAMMER, ESQ. | Agent | 41 COMSTOCK PARKWAY, CRANSTON, RI, 02921, USA |
| Name | Role | Address |
|---|---|---|
| STACEY LIEVENSE | TREASURER | 333 SCHOOL ST, SUITE 200 PAWTUCKET, RI 02860 USA |
| Name | Role | Address |
|---|---|---|
| LISA DOMAGALSKI | SECRETARY | 333 SCHOOL STREET, SUITE 200 PAWTUCKET, RI 02860 USA |
| Name | Role | Address |
|---|---|---|
| TOLGA KOKTURK | PRESIDENT | 333 SCHOOL STREET, STE 200 PAWTUCKET, RI 02860- USA |
| Number | Name | File Date |
|---|---|---|
| 202454465480 | Annual Report | 2024-05-16 |
| 202454465840 | Annual Report | 2024-05-16 |
| 202454465930 | Annual Report | 2024-05-16 |
| 202454466090 | Annual Report | 2024-05-16 |
| 202454466270 | Annual Report | 2024-05-16 |
| 202454466450 | Annual Report | 2024-05-16 |
| 202454465110 | Reinstatement | 2024-05-16 |
| 201924594330 | Revocation Certificate For Failure to File the Annual Report for the Year | 2019-10-18 |
| 201907071050 | Revocation Notice For Failure to File An Annual Report | 2019-07-24 |
| 201859154450 | Annual Report | 2018-02-27 |
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
