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  5. PMA, LLC

PMA, LLC

Company Details

Name: PMA, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Dissolved
Date of Organization in Rhode Island: 14 Sep 2010 (14 years ago)
Date of Dissolution: 16 Nov 2020 (4 years ago)
Date of Status Change: 16 Nov 2020 (4 years ago)
Identification Number: 000551200
ZIP code: 02860
County: Providence County
Principal Address: 174 ARMISTICE BLVD., PAWTUCKET, RI, 02860, USA
Purpose: TO PURCHASE, OWN AND OPERATE A MEDICAL PRACTICE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)
Fictitious names: Edgewood Medical (trading name, 2010-11-15 - )
Historical names: Park Medical Associates, LLC

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1033427398 2010-09-21 2010-09-23 PO BOX 205, MANVILLE, RI, 028380205, US 251 PARK AVE, CRANSTON, RI, 029052647, US

Contacts
Phone +1 800-927-0002

Authorized person
Name ROBERT CRAUSMAN
Role CHIEF MEDICAL OFFICER
Phone 8009270002

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PARK MEDICAL ASSOC LLC 2014 273453638 2017-04-17 PARK MEDICAL ASSOCIATES, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012750700
Plan sponsor’s address 174 ARMISTIVE BLVD., PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2017-04-17
Name of individual signing KRISTINA MAYER
Valid signature Filed with authorized/valid electronic signature
PARK MEDICAL ASSOC LLC 401 K PROFIT SHARING PLAN TRUST 2013 273453638 2014-07-15 PARK MEDICAL ASSOCIATES LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012750700
Plan sponsor’s address 174 ARMISTICE BLVD STE A, PAWTUCKET, RI, 028603269

Signature of
Role Plan administrator
Date 2014-07-15
Name of individual signing KRISTINA MAYER
Valid signature Filed with authorized/valid electronic signature
PARK MEDICAL ASSOC LLC 401 K PROFIT SHARING PLAN TRUST 2012 273453638 2013-07-30 PARK MEDICAL ASSOCIATES LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012750700
Plan sponsor’s address 174 ARMISTICE BLVD., PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2013-07-30
Name of individual signing PARK MEDICAL ASSOCIATES LLC
Valid signature Filed with authorized/valid electronic signature
PARK MEDICAL ASSOC LLC 401 K PROFIT SHARING PLAN TRUST 2011 273453638 2012-06-04 PARK MEDICAL ASSOCIATES LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012750700
Plan sponsor’s address 251 PARK AVE, CRANSTON, RI, 029052647

Plan administrator’s name and address
Administrator’s EIN 273453638
Plan administrator’s name PARK MEDICAL ASSOCIATES LLC
Plan administrator’s address 251 PARK AVE, CRANSTON, RI, 029052647
Administrator’s telephone number 4012750700

Signature of
Role Plan administrator
Date 2012-06-04
Name of individual signing PARK MEDICAL ASSOCIATES LLC
Valid signature Filed with authorized/valid electronic signature
PARK MEDICAL ASSOCIATES LLC 401 K PROFIT SHARING PLAN TRUST 2010 273453638 2011-07-29 PARK MEDICAL ASSOCIATES LLC 4
Three-digit plan number (PN) 001
Effective date of plan 2010-11-15
Business code 621111
Sponsor’s telephone number 4012750700
Plan sponsor’s address 251 PARK AVE, CRANSTON, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 273453638
Plan administrator’s name PARK MEDICAL ASSOCIATES LLC
Plan administrator’s address 251 PARK AVE, CRANSTON, RI, 02905
Administrator’s telephone number 4012750700

Signature of
Role Plan administrator
Date 2011-07-29
Name of individual signing PARK MEDICAL ASSOCIATES LLC
Valid signature Filed with incorrect/unrecognized electronic signature
PARK MEDICAL ASSOCIATES LLC 401 K PROFIT SHARING PLAN TRUST 2010 273453638 2012-01-26 PARK MEDICAL ASSOCIATES LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-11-15
Business code 621111
Sponsor’s telephone number 4012750700
Plan sponsor’s address 251 PARK AVE, CRANSTON, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 273453638
Plan administrator’s name PARK MEDICAL ASSOCIATES LLC
Plan administrator’s address 251 PARK AVE, CRANSTON, RI, 02905
Administrator’s telephone number 4012750700

Signature of
Role Plan administrator
Date 2012-01-26
Name of individual signing PARK MEDICAL ASSOCIATES LLC
Valid signature Filed with authorized/valid electronic signature

Agent

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

MANAGER

Name Role Address
ROBERT S CRAUSMAN MD MANAGER FIVE ADAMS CIRCLE REHOBOTH, MA 02769 USA
SCOTT WILSON MD MANAGER 8 CHRISTOPHER DRIVE LINCOLN, RI 02865-4945 USA

Events

Type Date Old Value New Value
Name Change 2012-08-31 Park Medical Associates, LLC PMA, LLC

Filings

Number Name File Date
202075394200 Articles of Dissolution 2020-11-16
202072410480 Annual Report 2020-11-06
202032761890 Statement of Change of Registered/Resident Agent 2020-01-21
201921568640 Annual Report 2019-09-27
201879147870 Annual Report 2018-10-10
201752532670 Annual Report 2017-10-31
201609132590 Annual Report 2016-09-21
201589026580 Annual Report 2015-12-10
201558184640 Annual Report 2015-03-30
201557558280 Revocation Notice For Failure to File An Annual Report 2015-03-16

Related by officers

STEPHEN D. ZUBIAGO, ESQ.

Nicholas A. Califano, M.D., Inc. CARDIOLOGY ASSOCIATES, INC. MIRIAM IPA, INC. ORTHOPEDIC GROUP, INC. Bayside Endoscopy Group, Inc. Mobile Storage Inc. H & H TRUCKING INC. MIRIAM PHO, INC. Bayside OB-GYN, Inc. West Bay Orthopaedics and Neurosurgery, Inc.

SCOTT WILSON MD

SC&M Property Group, llc Omnibus Reconciliation Inc. Arches Rhode Island PC

Related by address

No related companies by address

Date of last update: 14 Oct 2024

Sources: Rhode Island Department of State

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