| Name: | Cavicchio Podiatry LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 26 Jul 2016 (8 years ago) |
| Date of Dissolution: | 21 Feb 2022 (3 years ago) |
| Date of Status Change: | 21 Feb 2022 (3 years ago) |
| Identification Number: | 001665360 |
| ZIP code: | 02865 |
| County: | Providence County |
| Principal Address: | 25 GREENWOOD LANE, LINCOLN, RI, 02865, USA |
| Purpose: | PODIATRIC MEDICINE |
| NAICS: | 621391 - Offices of Podiatrists |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144773623 | 2016-08-01 | 2016-08-01 | 2 WAKE ROBIN RD, UNIT 203, LINCOLN, RI, 028654295, US | 2 WAKE ROBIN RD, UNIT 203, LINCOLN, RI, 028654295, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-312-9999 |
| Fax | 4013120416 |
Authorized person
| Name | DR. CHARLES M CAVICCHIO |
| Role | OWNER |
| Phone | 4013129999 |
Taxonomy
| Taxonomy Code | 213EP1101X - Primary Podiatric Medicine Podiatrist |
| License Number | DPM 206 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 213ES0131X - Foot Surgery Podiatrist |
| License Number | DPM 206 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED HEALTH CARE |
| Number | 2700124 |
| State | RI |
| Issuer | MEDICAID |
| Number | 9007036 |
| State | RI |
| Issuer | AETNA |
| Number | 0536455 |
| State | RI |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 70366 |
| State | RI |
| Issuer | MULTIPLAN |
| Number | P12001350 |
| State | RI |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 770036 |
| State | MA |
| Issuer | BLUE CHIP |
| Number | 000432 |
| State | RI |
| Issuer | RAILROAD MEDICARE |
| Number | 480001530 |
| State | RI |
| Issuer | CIGNA |
| Number | 0475951001 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| DR CHARLES CAVICCHIO | Agent | 25 GREENWOOD LANE, LINCOLN, RI, 02865, USA |
| Number | Name | File Date |
|---|---|---|
| 202211257640 | Articles of Dissolution | 2022-02-21 |
| 202102882340 | Annual Report | 2021-10-07 |
| 202057956420 | Statement of Change of Registered/Resident Agent | 2020-09-25 |
| 202057115890 | Annual Report | 2020-09-22 |
| 201917515470 | Annual Report | 2019-09-08 |
| 201880362990 | Annual Report | 2018-10-29 |
| 201750995530 | Annual Report | 2017-10-10 |
| 201602625440 | Articles of Organization | 2016-07-26 |
Date of last update: 26 Oct 2024
Sources: Rhode Island Department of State
