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  5. BRIAN G KWETKOWSKI, LLC

BRIAN G KWETKOWSKI, LLC

Company Details

Name: BRIAN G KWETKOWSKI, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Dissolved
Date of Organization in Rhode Island: 05 Aug 2019 (5 years ago)
Date of Dissolution: 28 Dec 2022 (2 years ago)
Date of Status Change: 28 Dec 2022 (2 years ago)
Identification Number: 001698739
ZIP code: 02886
County: Kent County
Principal Address: 274 LARCHWOOD DRIVE, WARWICK, RI, 02886, USA
Purpose: PRIMARY CARE PHYSICIAN OFFICE, PRIVATE PRACTICE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)
Historical names: DR. BRIAN G. KWETKOWKSI, LLC

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1659913549 2019-10-11 2019-11-14 3461 S COUNTY TRL STE 303, EAST GREENWICH, RI, 028181463, US 3461 S COUNTY TRL STE 303, EAST GREENWICH, RI, 028181463, US

Contacts
Phone +1 401-471-6510
Fax 4014716530

Authorized person
Name BRIAN G KWETKOWSKI
Role OWNER/ PHYSICIAN
Phone 4014716510

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BRIAN G. KWETKOWSKI RETIREMENT PLAN 2011 050520716 2012-01-25 BRIAN G. KWETKOWSKI 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 4013534422
Plan sponsor’s address 37 AUBURN AVENUE, JOHNSTON, RI, 02919

Plan administrator’s name and address
Administrator’s EIN 050520716
Plan administrator’s name BRIAN G. KWETKOWSKI
Plan administrator’s address 37 AUBURN AVENUE, JOHNSTON, RI, 02919
Administrator’s telephone number 4013534422

Signature of
Role Plan administrator
Date 2012-01-25
Name of individual signing BRIAN G. KWETKOWSKI
Valid signature Filed with authorized/valid electronic signature
BRIAN G. KWETKOWSKI RETIREMENT PLAN 2010 050520716 2011-05-25 BRIAN G. KWETKOWSKI 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 4013534422
Plan sponsor’s address 37 AUBURN AVENUE, JOHNSTON, RI, 02919

Plan administrator’s name and address
Administrator’s EIN 050520716
Plan administrator’s name BRIAN G. KWETKOWSKI
Plan administrator’s address 37 AUBURN AVENUE, JOHNSTON, RI, 02919
Administrator’s telephone number 4013534422

Signature of
Role Plan administrator
Date 2011-05-25
Name of individual signing BRIAN G. KWETKOWSKI
Valid signature Filed with authorized/valid electronic signature
BRIAN G. KWETKOWSKI RETIREMENT PLAN 2009 050520716 2010-08-30 BRIAN G. KWETKOWSKI 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 4013534422
Plan sponsor’s address 37 AUBURN AVENUE, JOHNSTON, RI, 02919

Plan administrator’s name and address
Administrator’s EIN 050520716
Plan administrator’s name BRIAN G. KWETKOWSKI
Plan administrator’s address 37 AUBURN AVENUE, JOHNSTON, RI, 02919
Administrator’s telephone number 4013534422

Signature of
Role Plan administrator
Date 2010-08-30
Name of individual signing BRIAN G. KWETKOWSKI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DR. BRIAN G. KWETKOWSKI Agent 274 LARCHWOOD DRIVE, WARWICK, RI, 02886, USA

Events

Type Date Old Value New Value
Name Change 2019-12-13 DR. BRIAN G. KWETKOWKSI, LLC BRIAN G KWETKOWSKI, LLC

Filings

Number Name File Date
202225532010 Articles of Dissolution 2022-12-28
202211218920 Annual Report 2022-02-20
202207610910 Statement of Change of Registered/Resident Agent Office 2022-01-04
202101014760 Annual Report 2021-09-07
202194935650 Annual Report 2021-03-25
202194281810 Revocation Notice For Failure to File An Annual Report 2021-03-16
201929865660 Articles of Amendment 2019-12-13
201910237450 Articles of Organization 2019-08-05

Related by officers

DR. BRIAN G. KWETKOWSKI

DR. BRIAN G. KWETKOWSKI FAMILY MEDICINE, LLC

Related by address

No related companies by address

Date of last update: 27 Oct 2024

Sources: Rhode Island Department of State

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