| Name: | Brown Urology, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 07 Apr 2017 (8 years ago) |
| Identification Number: | 001672642 |
| ZIP code: | 02905 |
| County: | Providence County |
| Principal Address: | 195 COLLYER STREET SUITE 201, PROVIDENCE, RI, 02905, USA |
| Purpose: | TO PROMOTE HEALTH BY PROVIDING CLINICAL AND MEDICAL CARE TO PATIENTS AS THE FACULTY GROUP PRACTICE ORGANIZATION FOR THE DEPARTMENT OF UROLOGY AT THE WARREN ALPERT MEDICAL SCHOOL AT BROWN UNIVERSITY |
| NAICS: | 622110 - General Medical and Surgical Hospitals |
| Fictitious names: |
Collyer Street Operatory, Inc. (trading name, 2018-04-23 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184303984 | 2023-07-18 | 2023-08-01 | 110 ELM ST FL 3, PROVIDENCE, RI, 029034626, US | 825 N MAIN ST, PROVIDENCE, RI, 029045767, US | |||||||||||||||||
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| Phone | +1 401-270-4623 |
| Fax | 4015377241 |
| Phone | +1 401-521-9700 |
Authorized person
| Name | DONNA GORDON |
| Role | DIRECTOR, REVENUE CYCLE |
| Phone | 4014435107 |
Taxonomy
| Taxonomy Code | 2085R0001X - Radiation Oncology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| UNIVERSITY UROLOGICAL ASSOCIATES, INC 401K RETIREMENT PLAN | 2021 | 061470514 | 2022-05-09 | BROWN UROLOGY INC. | 90 | |||||||||||||||||||||||||||||||||
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| UNIVERSITY UROLOGICAL ASSOCIATES, INC 401K RETIREMENT PLAN | 2021 | 061470514 | 2022-08-24 | BROWN UROLOGY INC. | 4 | |||||||||||||||||||||||||||||||||
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| UNIVERSITY UROLOGICAL ASSOCIATES, INC 401K RETIREMENT PLAN | 2020 | 061470514 | 2021-05-18 | BROWN UROLOGY INC. | 101 | |||||||||||||||||||||||||||||||||
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| UNIVERSITY UROLOGICAL ASSOCIATES, INC 401K RETIREMENT PLAN | 2019 | 061470514 | 2020-07-29 | BROWN UROLOGY INC. | 99 | |||||||||||||||||||||||||||||||||
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| UNIVERSITY UROLOGICAL ASSOCIATES, INC 401K RETIREMENT PLAN | 2018 | 061470514 | 2019-07-25 | BROWN UROLOGY INC. | 99 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2019-07-25 |
| Name of individual signing | MARK SIGMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-07-25 |
| Name of individual signing | MARK SIGMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| STEPHEN D. ZUBIAGO, ESQ. | Agent | NIXON PEABODY LLP ONE CITIZENS PLAZA SUITE 500, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| SAMUEL EASTON M.D. | TREASURER | 195 COLLYER STREET, STE. 201 PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| SIMONE THAVASEELAN M.D. | SECRETARY | 195 COLLYER STREET, STE. 201 PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| GYAN PAREEK MD | PRESIDENT | 195 COLLYER STREET, SUITE 201 PROVIDENCE, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| GYAN PAREEK M.D. | DIRECTOR | 195 COLLYER STREET, STE. 201 PROVIDENCE, RI 02905 USA |
| GABRIELLA AVELLINO M.D. | DIRECTOR | 195 COLLYER STREET, STE. 201 PROVIDENCE, RI 02905 USA |
| SIMONE THAVASEELAN M.D. | DIRECTOR | 195 COLLYER STREET, STE. 201 PROVIDENCE, RI 02905 USA |
| DICKEN KO M.D. | DIRECTOR | 195 COLLYER STREET, STE. 201 PROVIDENCE, RI 02905 USA |
| SAMUEL EASTON M.D. | DIRECTOR | 195 COLLYER STREET, STE. 201 PROVIDENCE, RI 02905 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Merged | 2018-01-29 | University Urological Associates, Inc. on | Brown Urology, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202450219960 | Annual Report | 2024-04-05 |
| 202332052030 | Annual Report | 2023-03-30 |
| 202221581120 | Annual Report | 2022-07-22 |
| 202220506980 | Revocation Notice For Failure to File An Annual Report | 2022-06-28 |
| 202198849610 | Annual Report | 2021-06-30 |
| 202066510080 | Annual Report | 2020-10-20 |
| 201998225590 | Annual Report | 2019-06-20 |
| 201867717230 | Annual Report | 2018-05-29 |
| 201862682290 | Fictitious Business Name Statement | 2018-04-23 |
| 201856982470 | Articles of Merger | 2018-01-29 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DEFINITIVE CONTRACT | AWARD | 36C24124C0031 | 2024-02-01 | 2025-01-31 | 2025-01-31 | |||||||||||||||||||||||||
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| Obligated Amount | 325398.00 |
| Current Award Amount | 325398.00 |
| Potential Award Amount | 325398.00 |
Description
| Title | UROLOGY PHYSICIAN SERVICES |
| NAICS Code | 611310: COLLEGES, UNIVERSITIES, AND PROFESSIONAL SCHOOLS |
| Product and Service Codes | Q525: MEDICAL- UROLOGY |
Recipient Details
| Recipient | BROWN UROLOGY INC |
| UEI | QDFLETAA3HH5 |
| Recipient Address | UNITED STATES, 2 DUDLEY ST STE 175/185, PROVIDENCE, PROVIDENCE, RHODE ISLAND, 029053236 |
| Unique Award Key | CONT_AWD_36C24123N0355_3600_36C24123A0033_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 3150.00 |
| Current Award Amount | 3150.00 |
| Potential Award Amount | 3150.00 |
Description
| Title | FERTILITY TESTING WITH LOCAL AFFILIATED HOSPITAL |
| NAICS Code | 621511: MEDICAL LABORATORIES |
| Product and Service Codes | Q301: REFERENCE LABORATORY TESTING |
Recipient Details
| Recipient | BROWN UROLOGY INC |
| UEI | QDFLETAA3HH5 |
| Recipient Address | UNITED STATES, 2 DUDLEY ST STE 175/185, PROVIDENCE, PROVIDENCE, RHODE ISLAND, 029053236 |
Date of last update: 26 Oct 2024
Sources: Rhode Island Department of State
