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Coastal Foot & Ankle, Inc.

Coastal Foot & Ankle, Inc.

Company Details

Name:	Coastal Foot & Ankle, Inc.
Jurisdiction:	Rhode Island
Entity type:	Professional Service Corporation
Status:	Activ
Date of Organization in Rhode Island:	11 Sep 2017 (7 years ago)
Identification Number:	001677060
ZIP code:	02842
County:	Newport County
Principal Address:	850 AQUIDNECK AVENUE SUITE B, MIDDLETOWN, RI, 02842, USA
Purpose:	PODIATRY
NAICS:	621391 - Offices of Podiatrists

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1275052755

2017-09-15

2022-07-21

850 AQUIDNECK AVE, MIDDLETOWN, RI, 028427280, US

850 AQUIDNECK AVE, MIDDLETOWN, RI, 028427280, US

Contacts

Phone	+1 401-849-2157
Fax	4018488441

Authorized person

Name	JONATHAN SABOURIN
Role	OWNER
Phone	5082581717

Taxonomy

Taxonomy Code	213ES0103X - Foot & Ankle Surgery Podiatrist
License Number	DPM00316
State	RI
Is Primary	Yes
Taxonomy Code	261QM2500X - Medical Specialty Clinic/Center
License Number	2210
State	MA
Is Primary	No

Other Provider Identifiers

Issuer	MEDICAID
Number	FH00185
State	RI

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

COASTAL FOOT & ANKLE, INC. 401(K) PLAN

2023

822743641

2024-05-29

COASTAL FOOT & ANKLE, INC.

7

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621391
Sponsor’s telephone number	4018492157
Plan sponsor’s address	850 AQUIDNECK AVE, SUITE B, MIDDLETOWN, RI, 02842

COASTAL FOOT & ANKLE, INC. 401(K) PLAN

2022

822743641

2023-03-16

COASTAL FOOT & ANKLE, INC.

6

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621391
Sponsor’s telephone number	4018492157
Plan sponsor’s address	850 AQUIDNECK AVE, SUITE B, MIDDLETOWN, RI, 02842

COASTAL FOOT & ANKLE, INC. 401(K) PLAN

2021

822743641

2022-02-22

COASTAL FOOT & ANKLE, INC.

6

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621391
Sponsor’s telephone number	4018492157
Plan sponsor’s address	850 AQUIDNECK AVE, SUITE B, MIDDLETOWN, RI, 02842

COASTAL FOOT & ANKLE, INC. 401(K) PLAN

2020

822743641

2021-03-30

COASTAL FOOT & ANKLE, INC.

6

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621391
Sponsor’s telephone number	4018492157
Plan sponsor’s address	850 AQUIDNECK AVE, SUITE B, MIDDLETOWN, RI, 02842

COASTAL FOOT & ANKLE, INC. 401(K) PLAN

2019

822743641

2020-03-26

COASTAL FOOT & ANKLE, INC.

6

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621391
Sponsor’s telephone number	4018492157
Plan sponsor’s address	850 AQUIDNECK AVE, SUITE B, MIDDLETOWN, RI, 02842

COASTAL FOOT & ANKLE, INC. 401(K) PLAN

2018

822743641

2019-04-19

COASTAL FOOT & ANKLE, INC.

6

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621391
Sponsor’s telephone number	4018492157
Plan sponsor’s address	850 AQUIDNECK AVE, SUITE B, MIDDLETOWN, RI, 02842

Agent

Name	Role	Address
THOMAS J. MOYLAN, ESQ.	Agent	55 PINE STREET 5TH FLOOR, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name	Role	Address
JONATHAN SABOURIN, DPM	PRESIDENT	850 AQUIDNECK AVENUE, SUITE B MIDDLETOWN, RI 02842 USA

Filings

Number	Name	File Date
202454684070	Annual Report	2024-05-21
202331941920	Statement of Change of Registered/Resident Agent	2023-03-29
202331901690	Annual Report	2023-03-28
202217945550	Annual Report	2022-05-29
202189421890	Annual Report	2021-02-02
202033953410	Annual Report	2020-02-07
201987451920	Annual Report	2019-02-21
201755434430	Annual Report	2017-12-28
201749487570	Articles of Incorporation	2017-09-11

Date of last update: 27 Oct 2024

Sources: Rhode Island Department of State