| Name: | Hospital Internists of Westerly, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 04 Sep 2007 (17 years ago) |
| Date of Dissolution: | 23 Aug 2012 (12 years ago) |
| Date of Status Change: | 23 Aug 2012 (12 years ago) |
| Identification Number: | 000220328 |
| ZIP code: | 02891 |
| County: | Washington County |
| Principal Address: | 25 WELLS STREET, WESTERLY, RI, 02891, USA |
| Mailing Address: | 29 MOUNTAIN SPRING ROAD, FARMINGTON, CT, 06032, USA |
| Purpose: | PRIVATE PHYSICIAN PRACTICE located within the Westerly Hospital |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861689846 | 2007-10-03 | 2007-10-03 | 25 WELLS ST, WESTERLY, RI, 028912922, US | 25 WELLS ST, WESTERLY, RI, 028912922, US | |||||||||||||||||||||||
|
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| Phone | +1 860-271-4364 |
| Fax | 8604445114 |
Authorized person
| Name | KENNETH W DONOVAN |
| Role | MEDICAL DIRECTOR |
| Phone | 8602714364 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| KENNETH W. DONOVAN, M.D. | Agent | THE WESTERLY HOSPITAL 25 WELLS STREET, WESTERLY, RI, 02891, USA |
| Name | Role | Address |
|---|---|---|
| J KEVIN SHUSHTARI MD | Manager | 29 MOUNTAIN SPRING RD FARMINGTON, CT 06032 USA |
| Number | Name | File Date |
|---|---|---|
| 201296337120 | Articles of Dissolution | 2012-08-23 |
| 201293643170 | Annual Report | 2012-06-04 |
| 201292575120 | Revocation Notice For Failure to File An Annual Report | 2012-05-07 |
| 201180192800 | Annual Report | 2011-06-15 |
| 201177761390 | Revocation Notice For Failure to File An Annual Report | 2011-04-04 |
| 200950521370 | Annual Report | 2009-09-02 |
| 200944841440 | Annual Report | 2009-04-06 |
| 200944491050 | Revocation Notice For Failure to File An Annual Report | 2009-03-25 |
| 200700392670 | Articles of Organization | 2007-09-04 |
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
