Basic Information
| Provider Information | |||||||||
| NPI: | 1649494188 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REX HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REX HOSPITAL TRANSPORT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2709 BLUE RIDGE RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197843467 | ||||||||
| FaxNumber: | 9197843004 | ||||||||
| Practice Location | |||||||||
| Address1: | 2709 BLUE RIDGE RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197844608 | ||||||||
| FaxNumber: | 9197844786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | SPONG | ||||||||
| AuthorizedOfficialFirstName: | BERNADETTE | ||||||||
| AuthorizedOfficialMiddleName: | MCMULLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9197843467 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1580 | NC | N | Transportation Services | Ambulance | Land Transport | 343900000X | 1580 | NC | Y | Transportation Services | Non-emergency Medical Transport (VAN) |
ID Information
| ID | Type | State | Issuer | Description | 3406898 | 05 | NC | MEDICAID |