| Name: | PEDIATRIC ENDOCRINOLOGY OF RHODE ISLAND, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 17 Aug 2012 (12 years ago) |
| Identification Number: | 000792493 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 4 RICHMOND SQUARE SUITE 150, PROVIDENCE, RI, 02906, USA |
| Mailing Address: | 24 OAKFIELD DRIVE, MARION BRIDGE NOVA SCOTIA, CAN |
| Purpose: | MEDICAL SERVICES |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073864591 | 2012-09-24 | 2014-04-01 | 50 AMARAL ST, EAST PROVIDENCE, RI, 029152205, US | 105 SOCKANOSSET CROSS ROAD, SUITE 318, CRANSTON, RI, 02920, US | |||||||||||||||||||||||||||||
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| Phone | +1 401-434-2058 |
| Fax | 4016336854 |
Authorized person
| Name | REBECCA MCEACHERN |
| Role | SOLE OWNER/ MEDICAL DIRECTOR |
| Phone | 4014198091 |
Taxonomy
| Taxonomy Code | 2080P0205X - Pediatric Endocrinology Physician |
| License Number | 11312 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED HEALTHCARE |
| Number | 3300486 |
| Issuer | MEDICAID |
| Number | PE91323 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| AMY E. STRATTON, ESQ. | Agent | 4 RICHMOND SQUARE SUITE 150, PROVIDENCE, RI, 02906, USA |
| Number | Name | File Date |
|---|---|---|
| 202453321200 | Annual Report | 2024-04-30 |
| 202330970480 | Annual Report | 2023-03-16 |
| 202211608370 | Annual Report | 2022-02-25 |
| 202104174830 | Annual Report | 2021-10-28 |
| 202071117740 | Annual Report | 2020-11-03 |
| 201927641950 | Annual Report | 2019-11-18 |
| 201879949050 | Annual Report | 2018-10-23 |
| 201755019420 | Annual Report | 2017-12-13 |
| 201609027670 | Annual Report | 2016-09-19 |
| 201691161140 | Statement of Change of Registered/Resident Agent Office | 2016-01-22 |
Date of last update: 17 Oct 2024
Sources: Rhode Island Department of State
