| 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) |
| 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
