1164464541 NPI number — REX HOSPITAL, INC.

Table of content: JEFFREY SCOTT GORDON LPT (NPI 1356579064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164464541 NPI number — REX HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REX HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164464541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 SUNDAY DR
Provider Second Line Business Mailing Address:
SUITE 113
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-5151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-784-4442
Provider Business Mailing Address Fax Number:
919-784-4548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SUNDAY DR
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-5151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-784-4442
Provider Business Practice Location Address Fax Number:
919-784-4548
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZUKOWSKI
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
919-784-6422

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC0422 944099 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3407176 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3417176 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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