| Name: | Cavicchio Podiatry LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 26 Jul 2016 (9 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 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 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
