| Name: | George A. Southiere, Jr., MD, P.C. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 12 Nov 2010 (14 years ago) |
| Date of Dissolution: | 02 Nov 2017 (7 years ago) |
| Date of Status Change: | 02 Nov 2017 (7 years ago) |
| Identification Number: | 000559032 |
| ZIP code: | 02920 |
| County: | Providence County |
| Principal Address: | 105 SOCKANOSSET CROSS ROAD SUITE 320, CRANSTON, RI, 02920, USA |
| Purpose: | MEDICINE |
| Fictitious names: |
Ocean State Addiction Medicine (trading name, 2013-01-25 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578864187 | 2010-11-12 | 2010-11-12 | 600 PUTNAM PIKE, SUITE 7, GREENVILLE, RI, 028281486, US | 600 PUTNAM PIKE, SUITE 7, GREENVILLE, RI, 028281486, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 401-258-4535 |
Authorized person
| Name | DR. GEORGE ARMAND SOUTHIERE JR. |
| Role | OWNER |
| Phone | 4012584535 |
Taxonomy
| Taxonomy Code | 207QA0401X - Addiction Medicine (Family Medicine) Physician |
| License Number | MD09907 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GEORGE A. SOUTHIERE, JR. | Agent | 105 SOCKANOSSET CROSS ROAD SUITE 320, CRANSTON, RI, 02920, USA |
| Name | Role | Address |
|---|---|---|
| GEORGE A SOUTHIERE, JR. | PRESIDENT | 23 WINDSONG ROAD CUMBERLAND, RI 02864 USA |
| Number | Name | File Date |
|---|---|---|
| 201752809880 | Revocation Certificate For Failure to File the Annual Report for the Year | 2017-11-02 |
| 201747843710 | Revocation Notice For Failure to File An Annual Report | 2017-07-27 |
| 201694802310 | Annual Report | 2016-03-17 |
| 201558085370 | Annual Report | 2015-03-26 |
| 201440129300 | Annual Report | 2014-05-28 |
| 201439615870 | Revocation Notice For Failure to File An Annual Report | 2014-05-20 |
| 201329098280 | Statement of Change of Registered Office by the Registered Agent | 2013-10-03 |
| 201329097850 | Statement of Change of Registered Office by the Registered Agent | 2013-10-03 |
| 201329089620 | Annual Report - Amended | 2013-10-03 |
| 201313370600 | Annual Report | 2013-03-01 |
Date of last update: 14 Oct 2024
Sources: Rhode Island Department of State
