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Eric P. Berthiaume Medical, Inc.

Company Details

Name: Eric P. Berthiaume Medical, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 24 Mar 2008 (17 years ago)
Date of Dissolution: 28 Feb 2012 (13 years ago)
Date of Status Change: 28 Feb 2012 (13 years ago)
Identification Number: 000319000
ZIP code: 02905
County: Providence County
Principal Address: 33 STANIFORD STREET, PROVIDENCE, RI, 02905, USA
Purpose: MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1477728624 2008-04-29 2008-07-15 1407 SOUTH COUNTY TRAIL, BUILDING 4 SUITE 410, EAST GREENWICH, RI, 02818, US 1407 SOUTH COUNTY TRAIL, BUILDING 4 SUITE 410, EAST GREENWICH, RI, 02818, US

Contacts

Phone +1 401-886-4040
Fax 4018864010

Authorized person

Name DR. ERIC P. BERTHIAUME
Role PHYSICIAN/OWNER
Phone 4014218800

Taxonomy

Taxonomy Code 207RG0100X - Gastroenterology Physician
License Number 11821
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ERIC P. BERTHIAUME MEDICAL, INC. RETIREMENT PLAN 2012 262242558 2013-06-20 ERIC P. BERTHIAUME MEDICAL, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4014218800
Plan sponsor’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address

Administrator’s EIN 262242558
Plan administrator’s name ERIC P. BERTHIAUME MEDICAL, INC.
Plan administrator’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4014218800

Signature of

Role Plan administrator
Date 2013-06-20
Name of individual signing JAMES W. STAUFFER
Valid signature Filed with authorized/valid electronic signature
ERIC P. BERTHIAUME MEDICAL, INC. RETIREMENT PLAN 2011 262242558 2012-07-09 ERIC P. BERTHIAUME MEDICAL, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4014218800
Plan sponsor’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address

Administrator’s EIN 262242558
Plan administrator’s name ERIC P. BERTHIAUME MEDICAL, INC.
Plan administrator’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4014218800

Signature of

Role Plan administrator
Date 2012-07-09
Name of individual signing ERIC P. BERTHIAUME
Valid signature Filed with authorized/valid electronic signature
ERIC P. BERTHIAUME MEDICAL, INC. RETIREMENT PLAN 2010 262242558 2011-07-05 ERIC P. BERTHIAUME MEDICAL, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4014218800
Plan sponsor’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address

Administrator’s EIN 262242558
Plan administrator’s name ERIC P. BERTHIAUME MEDICAL, INC.
Plan administrator’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4014218800

Signature of

Role Plan administrator
Date 2011-07-05
Name of individual signing ERIC P. BERTHIAUME
Valid signature Filed with authorized/valid electronic signature
ERIC P. BERTHIAUME MEDICAL, INC. RETIREMENT PLAN 2009 262242558 2010-10-14 ERIC P. BERTHIAUME MEDICAL, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4014218800
Plan sponsor’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address

Administrator’s EIN 262242558
Plan administrator’s name ERIC P. BERTHIAUME MEDICAL, INC.
Plan administrator’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4014218800

Signature of

Role Plan administrator
Date 2010-10-14
Name of individual signing CAROL LIPMAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
STEPHEN D. ZUBIAGO Agent NIXON PEABODY LLP ONE CITIZENS PLAZA SUITE 500, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
ERIC P BERTHIAUME MD PRESIDENT 33 STANIFORD STREET PROVIDENCE, RI 02905 USA

Filings

Number Name File Date
201290323750 Articles of Dissolution 2012-02-28
201174252080 Annual Report 2011-01-31
201058474610 Annual Report 2010-02-16
200943313380 Annual Report 2009-02-26
200808470450 Articles of Incorporation 2008-03-24

Date of last update: 12 Oct 2024

Sources: Rhode Island Department of State