| Name: | Providence Interventional Pain, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 17 Feb 2009 (16 years ago) |
| Identification Number: | 000504537 |
| ZIP code: | 02895 |
| County: | Providence County |
| Principal Address: | 20 CUMBERLAND HILL RD SUITE#105, WOONSOCKET, RI, 02895, USA |
| Mailing Address: | 139 HOMEWARD LANE, NORTH ATTLEBORO, MA, 02760, USA |
| Purpose: | MEDICAL OFFICE |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851699441 | 2011-03-05 | 2023-05-09 | PO BOX 426, SOUTHBRIDGE, MA, 015500426, US | 20 CUMBERLAND HILL RD, SUITE#105, WOONSOCKET, RI, 028954883, US | |||||||||||||||||||||||
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| Phone | +1 401-597-0985 |
| Fax | 4015970987 |
Authorized person
| Name | DR. ASHRAF FARID |
| Role | PRESIDENT |
| Phone | 4015970985 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | MD11073 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ASHRAF FARID | Agent | 20 CUMBERLAND HILL ROAD SUITE 105, WOONSOCKET, RI, 02895, USA |
| Number | Name | File Date |
|---|---|---|
| 202445042520 | Annual Report | 2024-01-30 |
| 202338992240 | Annual Report | 2023-07-02 |
| 202337193350 | Revocation Notice For Failure to File An Annual Report | 2023-06-16 |
| 202208362250 | Annual Report | 2022-01-21 |
| 202101204530 | Annual Report | 2021-09-10 |
| 202056320600 | Annual Report | 2020-09-20 |
| 202041038260 | Statement of Change of Registered/Resident Agent | 2020-05-28 |
| 202041035700 | Annual Report | 2020-05-28 |
| 202041038350 | Annual Report | 2020-05-28 |
| 202041034370 | Reinstatement | 2020-05-28 |
Date of last update: 14 Oct 2024
Sources: Rhode Island Department of State
