| Name: | WICKFORD FAMILY MEDICINE LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 01 Mar 2011 (14 years ago) |
| Date of Dissolution: | 22 Dec 2023 (a year ago) |
| Date of Status Change: | 22 Dec 2023 (a year ago) |
| Identification Number: | 000591669 |
| ZIP code: | 02852 |
| County: | Washington County |
| Principal Address: | 320 PHILLIPS STREET SUITE 102, NORTH KINGSTOWN, RI, 02852, USA |
| Purpose: | SOLO FAMILY PRACTICE PROVIDING MEDICAL CARE. |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104124734 | 2011-03-07 | 2011-03-07 | PO BOX 118, NORTH KINGSTOWN, RI, 028520118, US | 320 PHILLIPS ST, SUITE 204, NORTH KINGSTOWN, RI, 028525149, US | |||||||||||||||||
|
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| Phone | +1 401-450-2111 |
Authorized person
| Name | JOHN MACHATA |
| Role | MEDICAL DIRECTOR |
| Phone | 4014502111 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 08781 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JOHN JOSEPH MACHATA | Agent | 103 WEST MAIN STREET, NORTH KINGSTOWN, RI, 02852, USA |
| Number | Name | File Date |
|---|---|---|
| 202343551160 | Articles of Dissolution | 2023-12-22 |
| 202328266100 | Annual Report | 2023-02-13 |
| 202217719520 | Annual Report | 2022-05-20 |
| 202100610260 | Annual Report | 2021-09-01 |
| 202056040580 | Annual Report | 2020-09-21 |
| 201917182050 | Annual Report | 2019-09-03 |
| 201882760820 | Annual Report | 2018-12-17 |
| 201749089990 | Annual Report | 2017-09-05 |
| 201608310980 | Annual Report | 2016-09-03 |
| 201577832140 | Annual Report | 2015-09-05 |
Date of last update: 15 Oct 2024
Sources: Rhode Island Department of State
