Provider Demographics
NPI:1750319729
Name:REX HOSPITAL INC
Entity Type:Organization
Organization Name:REX HOSPITAL INC
Other - Org Name:REX FAMILY PRACTICE OF WAKEFIELD
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 1:11200 GOVERNOR MANLY WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6830
Mailing Address - Country:US
Mailing Address - Phone:919-570-7700
Mailing Address - Fax:919-570-7701
Practice Address - Street 1:11200 GOVERNOR MANLY WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6830
Practice Address - Country:US
Practice Address - Phone:919-570-7700
Practice Address - Fax:919-570-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014XVMedicaid
7607516OtherAETNA
NC014XVOtherBCBS
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