| Name: | Wickford Family Practice LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 29 Nov 2022 (2 years ago) |
| Identification Number: | 001749189 |
| ZIP code: | 02852 |
| County: | Washington County |
| Principal Address: | 619 BOSTON NECK ROAD, NORTH KINGSTOWN, RI, 02852, USA |
| Mailing Address: | 320 PHILLIPS STREETS SUITE 102, NORTH KINGSTOWN, RI, 02852, USA |
| Purpose: | SOLO PRACTICE PRIMARY CARE OFFICE RAN BY A NURSE PRACTITIONER. |
NAICS
621399 Offices of All Other Miscellaneous Health PractitionersThis U.S. industry comprises establishments of independent health practitioners (except physicians; dentists; chiropractors; optometrists; mental health specialists; physical, occupational, and speech therapists; audiologists; and podiatrists). 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 | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710698667 | 2022-12-12 | 2023-02-01 | 619 BOSTON NECK RD, NORTH KINGSTOWN, RI, 028526235, US | 320 PHILLIPS ST STE 102, NORTH KINGSTOWN, RI, 028525149, US | |||||||||||||||||||||||||||||
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| Phone | +1 603-667-6765 |
Authorized person
| Name | MAXWELL HOGUE |
| Role | OWNER |
| Phone | 6036676765 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1235789231 |
| State | RI |
| Issuer | STATE NP LICENSE |
| Number | APRN02399 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| MAXWELL HOGUE | Agent | 619 BOSTON NECK ROAD, NORTH KINGSTOWN, RI, 02852, USA |
| Number | Name | File Date |
|---|---|---|
| 202452088140 | Annual Report | 2024-04-23 |
| 202333047170 | Annual Report | 2023-04-17 |
| 202224923170 | Articles of Organization | 2022-11-29 |
Date of last update: 29 Oct 2024
Sources: Rhode Island Department of State
