| Name: | CENTERVILLE PODIATRY, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 09 May 2011 (14 years ago) |
| Date of Dissolution: | 14 Feb 2022 (3 years ago) |
| Date of Status Change: | 14 Feb 2022 (3 years ago) |
| Identification Number: | 000660931 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 469 CENTERVILLE ROAD #105, WARWICK, RI, 02886, USA |
| Purpose: | PODIATRY OFFICE |
NAICS
621391 Offices of PodiatristsThis U.S. industry comprises establishments of health practitioners having the degree of D.P.M. (Doctor of Podiatric Medicine) primarily engaged in the independent practice of podiatry. These practitioners diagnose and treat diseases and deformities of the foot and 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 | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871041491 | 2016-09-12 | 2016-09-12 | 469 CENTERVILLE RD, STE 105, WARWICK, RI, 028864354, US | 469 CENTERVILLE RD, STE 105, WARWICK, RI, 028864354, US | |||||||||||||||||||||||||||
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| Phone | +1 401-738-9200 |
| Fax | 4017389400 |
Authorized person
| Name | DR. GEORGE M MONIZ |
| Role | OWNER |
| Phone | 4017389200 |
Taxonomy
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | DPM277 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | DPM208 |
| State | RI |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| JOHN E. BUCCI, JR. | Agent | 2181 POST ROAD, WARWICK, RI, 02886, USA |
| Number | Name | File Date |
|---|---|---|
| 202210254370 | Revocation Certificate For Failure to File the Annual Report for the Year | 2022-02-14 |
| 202106425930 | Revocation Notice For Failure to File An Annual Report | 2021-12-03 |
| 202066151940 | Annual Report | 2020-10-19 |
| 201917891880 | Annual Report | 2019-09-06 |
| 201879739840 | Annual Report | 2018-10-19 |
| 201751566180 | Annual Report | 2017-10-14 |
| 201609435060 | Annual Report | 2016-09-27 |
| 201600646690 | Annual Report | 2016-06-14 |
| 201600647930 | Statement of Change of Registered/Resident Agent | 2016-06-14 |
| 201600650570 | Annual Report | 2016-06-14 |
Date of last update: 15 Oct 2024
Sources: Rhode Island Department of State
