Basic Information
| Provider Information | |||||||||
| NPI: | 1497797088 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REX HOSPITAL INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REX HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4420 LAKE BOONE TRL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197843100 | ||||||||
| FaxNumber: | 9197843004 | ||||||||
| Practice Location | |||||||||
| Address1: | 4420 LAKE BOONE TRL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197843100 | ||||||||
| FaxNumber: | 9197843004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ZUKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | KENNETH | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9197846422 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315D00000X | H0065 953429 | NC | N | Nursing & Custodial Care Facilities | Hospice, Inpatient | 343900000X | H0065 953429 | NC | N | Transportation Services | Non-emergency Medical Transport (VAN) | 282N00000X | H0065 953429 | NC | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00459 | 01 | NC | BLUE CROSS IP PROVIDER # | OTHER | 3400114 | 05 | NC | MEDICAID | 5052479 | 01 | NC | UNITED HEALTH CARE PLAN # | OTHER | 054585 | 01 | NC | AETNA | OTHER | 227677 | 01 | NC | MAMSI ALLIANCE PPO | OTHER | 5052479 | 01 | NC | UHC-MEDICARE COMPLETE | OTHER | 3401140 | 01 | NC | WELLPATH | OTHER | 910HOS | 01 | NC | PARTNERS | OTHER | 015A2 | 01 | NC | BLUE CROSS REHAB PROVIDER | OTHER | 3406898 | 05 | NC | MEDICAID | 00459 | 01 | NC | NC STATE GOV PLAN # | OTHER | 00460 | 01 | NC | NC STATE GOV PLAN # | OTHER | 00460 | 01 | NC | BLUE CROSS OP PROVIDER # | OTHER | 015A2 | 01 | NC | NC STATE GOV PLAN # | OTHER |