| Name: | AFFINITY PHYSICIANS, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 12 May 2010 (15 years ago) |
| Identification Number: | 000539865 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 4 RICHMOND SQUARE, PROVIDENCE, RI, 02906, USA |
| Mailing Address: | 4 RICHMOND SQUARE 4TH FLOOR, PROVIDENCE, RI, 02906, USA |
| Purpose: | PHYSICIAN MEDICAL GROUP |
| NAICS: | 621999 - All Other Miscellaneous Ambulatory Health Care Services |
| Fictitious names: |
Care New England Medical Group, LLC (trading name, 2015-11-24 - ) |
| Historical names: |
Kent Physician Enterprise, LLC |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053038471 | 2022-10-26 | 2024-03-26 | 455 TOLL GATE RD, CREDENTIALING-ANESTHESIOLOGY, WARWICK, RI, 028862759, US | 101 DUDLEY ST DEPT OF, PROVIDENCE, RI, 029052401, US | |||||||||||||||||||||
|
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| Phone | +1 401-273-0641 |
| Fax | 4012732919 |
| Phone | +1 401-274-1122 |
Authorized person
| Name | DAWN LYNN RODGERS |
| Role | CREDENTIALING SUPERVISOR |
| Phone | 4016595589 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| LISA MUNKELWITZ | Agent | 4 RICHMOND SQUARE, PROVIDENCE, RI, 02906, USA |
| Name | Role | Address |
|---|---|---|
| ROBERT SHALVOY | Manager | 19 GOLD STAR DRIVE CUMBERLAND, RI 02864 USA |
| JINEN THAKKAR MD | Manager | 455 TOLL GATE ROAD WARWICK, RI 02886 USA |
| JAMES SULLIVAN MD | Manager | 345 BLACKSTONE BLVD PROVIDENCE, RI 02906 USA |
| LAURA FORMAN | Manager | 332 NORTH QUIDNESSETT ROAD NORTH KINGSTOWN, RI 02852 USA |
| RODOLFO GALINATTI | Manager | 16 RAYMOND DRIVE ATTLEBORO, MA 02703 USA |
| METHODIUS TUULI | Manager | 190 LYNN CIRCLE EAST GREENWICH, RI 02818 USA |
| RONALD CRANDALL | Manager | 300 RICHMOND STREET PROVIDENCE, RI 02903 USA |
| CHRISTIE L. DIBBLE | Manager | 11 JODIE BETH DRIVE EAST GREENWICH, RI 02818 USA |
| LISA UEBELACKER | Manager | 17 DEBORAH SAMPSON STREET SHARON, MA 02067 USA |
| LINDA NANNI | Manager | 247 CORNELL ROAD WESTPORT, MA 02790 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2010-09-07 | Kent Physician Enterprise, LLC | AFFINITY PHYSICIANS, LLC |
| Number | Name | File Date |
|---|---|---|
| 202451879000 | Annual Report | 2024-04-22 |
| 202334797650 | Annual Report | 2023-05-01 |
| 202221735190 | Statement of Change of Registered/Resident Agent Office | 2022-07-28 |
| 202215937520 | Annual Report | 2022-04-27 |
| 202104484830 | Annual Report - Amended | 2021-11-02 |
| 202104057430 | Annual Report | 2021-10-27 |
| 202192113320 | Annual Report | 2021-02-19 |
| 201915993630 | Annual Report | 2019-08-28 |
| 201915681230 | Statement of Change of Registered/Resident Agent | 2019-08-27 |
| 201876295880 | Annual Report | 2018-08-30 |
Date of last update: 14 Oct 2024
Sources: Rhode Island Department of State
