Provider Demographics
NPI:1578809489
Name:REX HOSPITAL INC
Entity Type:Organization
Organization Name:REX HOSPITAL INC
Other - Org Name:REX HOSPITAL PELVIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-784-3245
Mailing Address - Street 1:4325 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7509
Mailing Address - Country:US
Mailing Address - Phone:919-784-2840
Mailing Address - Fax:919-784-2841
Practice Address - Street 1:4325 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7509
Practice Address - Country:US
Practice Address - Phone:919-784-2840
Practice Address - Fax:919-784-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208800000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty