| Name: | Rhode Island Health Group Pain Management, P.C. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 19 Feb 2021 (4 years ago) |
| Date of Dissolution: | 12 Oct 2022 (2 years ago) |
| Date of Status Change: | 12 Oct 2022 (2 years ago) |
| Identification Number: | 001719604 |
| Purpose: | MEDICAL PRACTICE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720681000 | 2020-11-18 | 2023-10-10 | 65 EDDIE DOWLING HWY, NORTH SMITHFIELD, RI, 028967305, US | 63 EDDIE DOWLING HWY, NORTH SMITHFIELD, RI, 028967322, US | |||||||||||||||||||
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| Phone | +1 401-597-5353 |
| Fax | 4017694555 |
| Phone | +1 401-356-4088 |
| Fax | 4016716139 |
Authorized person
| Name | NASIR A BHATTI |
| Role | MEDICAL DIRECTOR |
| Phone | 4013564088 |
Taxonomy
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SYED IFTIKHAR HUSSAIN MD | Agent | 3 BRIDLE DRIVE, LINCOLN, RI, 02865, USA |
| Name | Role | Address |
|---|---|---|
| SYED IFTIKHAR HUSSAIN MD | INCORPORATOR | 3 BRIDLE DRIVE LINCOLN, RI 02865 USA |
| Number | Name | File Date |
|---|---|---|
| 202223986770 | Revocation Certificate For Failure to File the Annual Report for the Year | 2022-10-12 |
| 202220280150 | Revocation Notice For Failure to File An Annual Report | 2022-06-27 |
| 202192426150 | Articles of Incorporation | 2021-02-19 |
Date of last update: 28 Oct 2024
Sources: Rhode Island Department of State
