| 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 (6 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 |
| Historical names: |
DR. BRIAN G. KWETKOWKSI, LLC |
NAICS
621111 Offices of Physicians (except Mental Health Specialists)This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners 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 | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |||||||||||||||
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| 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 |
| 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 | |||||||||||||||||||||||||||||||
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| 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 |
| 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 |
| 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 |
| Name | Role | Address |
|---|---|---|
| DR. BRIAN G. KWETKOWSKI | Agent | 274 LARCHWOOD DRIVE, WARWICK, RI, 02886, USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2019-12-13 | DR. BRIAN G. KWETKOWKSI, LLC | BRIAN G KWETKOWSKI, LLC |
| 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 |
Date of last update: 27 Oct 2024
Sources: Rhode Island Department of State
