# BLACKSTONE MEDICAL CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STEWARD MEDICAL HOLDINGS, LLC
- **Other names:** Blackstone Medical Center Spine Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396090536
- **Legal business name:** STEWARD MEDICAL HOLDINGS, LLC
- **Authorized official:** MR. JAMES RENNA (CFO)
- **Authorized official phone:** (617) 419-4772

## Contact information

- **Practice address:** 219 CASS AVENUE, WOONSOCKET, RI 02895-4741
- **Practice address phone:** (401) 769-4100
- **Practice address fax:** (401) 766-9575
- **Mailing address:** PO BOX 845582, BOSTON, MA 02284-5582
- **Mailing address phone:** (401) 769-4100
- **Mailing address fax:** (401) 766-9575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 00117 | RI | — |
| 207X00000X | Orthopaedic Surgery Physician | 00117 | RI | Yes |
| 208600000X | Surgery Physician | 00117 | RI | — |
| 2086X0206X | Surgical Oncology Physician | 00117 | RI | — |

## Other

- **Enumeration date:** 07/13/2012
- **Last updated:** 08/01/2012