| Name: | FAIRFAX ACNE & DERMATOLOGY SERVICES, P.C. |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 21 Dec 2022 (2 years ago) |
| Identification Number: | 001750031 |
| ZIP code: | 02914 |
| County: | Providence County |
| Place of Formation: | MASSACHUSETTS |
| Principal Address: | 1275 WAMPANOAG TRAIL SUITE 6, EAST PROVIDENCE, RI, 02914, USA |
| Purpose: | TO ENGAGE IN THE BUSINESS OF PROVIDING DERMATOLOGIC CONSULTING AND MEDICAL SERVICES, AS A LICENSED NURSE PRACTITIONER TO INDIVIDUAL PATIENTS |
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 | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245947332 | 2022-10-31 | 2022-10-31 | 1275 WAMPANOAG TRAIL, STE. 6, EAST PROVIDENCE, RI, 029151217, US | 1275 WAMPANOAG TRAIL, STE. 6, EAST PROVIDENCE, RI, 029151217, US | |||||||||||||
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| Phone | +1 508-404-4853 |
Authorized person
| Name | DIANA L FAIRFAX |
| Role | OWNER |
| Phone | 5084043853 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| REGISTERED AGENT SOLUTIONS, INC. | Agent | 222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA |
| Name | Role | Address |
|---|---|---|
| DIANA L. FAIRFAX | PRESIDENT | 103 GULF ROAD SOUTH DARTMOUTH, MA 02748 USA |
| Number | Name | File Date |
|---|---|---|
| 202453779740 | Annual Report | 2024-05-02 |
| 202338948580 | Annual Report | 2023-06-30 |
| 202338329820 | Revocation Notice For Failure to File An Annual Report | 2023-06-19 |
| 202225426490 | Application for Certificate of Authority | 2022-12-21 |
Date of last update: 29 Oct 2024
Sources: Rhode Island Department of State
