| 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)This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 9002997101 | 2020-04-15 | 0165 | PPP | 20 CUMBERLAND HILL RD, WOONSOCKET, RI, 02895-4883 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 14 Oct 2024
Sources: Rhode Island Department of State
