Provider Demographics
NPI:1457621765
Name:REX PHYSICIANS LLC
Entity Type:Organization
Organization Name:REX PHYSICIANS LLC
Other - Org Name:REX COMPREHENSIVE VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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 1:2800 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6478
Mailing Address - Country:US
Mailing Address - Phone:919-784-8346
Mailing Address - Fax:919-784-2708
Practice Address - Street 1:2800 BLUE RIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6478
Practice Address - Country:US
Practice Address - Phone:919-784-8346
Practice Address - Fax:919-784-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347365Medicare PIN