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)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 | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
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 | |||||||||||||||||
|
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