Provider Demographics
NPI:1013425933
Name:REX SURGERY CENTER OF WAKEFIELD, LLC
Entity Type:Organization
Organization Name:REX SURGERY CENTER OF WAKEFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-784-1440
Mailing Address - Street 1:11200 GOVERNOR MANLY WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7360
Mailing Address - Country:US
Mailing Address - Phone:919-570-7510
Mailing Address - Fax:919-570-7511
Practice Address - Street 1:11200 GOVERNOR MANLY WAY STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7360
Practice Address - Country:US
Practice Address - Phone:919-570-7510
Practice Address - Fax:919-570-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical