Basic Information
| Provider Information | |||||||||
| NPI: | 1134404437 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REX HOSPITAL INC | ||||||||
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| OtherOrganizationName: | REX EXPRESS CARE OF HOLLY SPRINGS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 781 AVENT FERRY RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275407776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195676120 | ||||||||
| FaxNumber: | 9195676121 | ||||||||
| Practice Location | |||||||||
| Address1: | 781 AVENT FERRY ROAD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275408931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195676120 | ||||||||
| FaxNumber: | 9195676121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2011 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOOLEY | ||||||||
| AuthorizedOfficialFirstName: | MEGHAN | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CORPORATE FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 9197847711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 025VW | 01 | NC | BCBS GROUP # | OTHER |