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Organization
REX HOSPITAL INC
Active
Organization
REX HOSPITAL INC
Active
Other names
Rex Family Practice of Wakefield
Organization subpart
No
Provider details
NPI number
Authorized official
BERNADETTE M SPONG (CFO)
(919) 784-3245
Entity
Organization
Contact information
Practice address
11200 GOVERNOR MANLY WAY, SUITE 205, RALEIGH, NC 27614-6830
(919) 570-7700
(919) 570-7701
Mailing address
11200 GOVERNOR MANLY WAY, SUITE 205, RALEIGH, NC 27614-6830
(919) 570-7700
(919) 570-7701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014XV
BCBS
NC
01
—
7607516
AETNA
—
05
—
89014XV
—
NC
Enumeration date
06/29/2006
Last updated
04/28/2009
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