| Name: | Infectious Diseases Associates of Rhode Island, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 09 Jun 2011 (14 years ago) |
| Identification Number: | 000683545 |
| ZIP code: | 02895 |
| County: | Providence County |
| Principal Address: | 115 CASS AVENUE, WOONSOCKET, RI, 02895, USA |
| Mailing Address: | 109 AIRPORT ROAD SUITE 8, WARWICK, RI, 02889, USA |
| Purpose: | TO PROVIDE 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 | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043507734 | 2011-07-01 | 2011-07-01 | 69 HIGHLAND AVE, WARWICK, RI, 028869418, US | 115 CASS AVENUE - 3RD FLOOR, C/O LANDMARK MEDICAL, WOONSOCKET, RI, 02895, US | |||||||||||||||||||||||||||||
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| Phone | +1 401-766-3428 |
| Fax | 4017671633 |
| Phone | +1 401-769-4100 |
Authorized person
| Name | DR. GLENN G FORT |
| Role | CEO |
| Phone | 4017663428 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| License Number | MD07281 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| License Number | 06195 |
| State | RI |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| RAYMOND M ANDOLFO | Agent | 109 AIRPORT ROAD SUITE 7, WARWICK, RI, 02889, USA |
| Number | Name | File Date |
|---|---|---|
| 202447948730 | Annual Report | 2024-03-06 |
| 202331286760 | Annual Report | 2023-03-22 |
| 202215899990 | Annual Report | 2022-04-27 |
| 202107026280 | Annual Report | 2021-12-13 |
| 202106368200 | Revocation Notice For Failure to File An Annual Report | 2021-12-03 |
| 202185111470 | Annual Report | 2021-01-07 |
| 201927287310 | Annual Report | 2019-11-11 |
| 201988500140 | Statement of Change of Registered/Resident Agent | 2019-03-13 |
| 201988499930 | Annual Report | 2019-03-13 |
| 201748820800 | Annual Report | 2017-08-28 |
Date of last update: 16 Oct 2024
Sources: Rhode Island Department of State
