Healthcare Provider Details

I. General information

NPI: 1912977612
Provider Name (Legal Business Name): WOMENS LIFE CENTER OF LUMBERTON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAKRIDGE BLVD
LUMBERTON NC
28358-2330
US

IV. Provider business mailing address

800 OAKRIDGE BLVD
LUMBERTON NC
28358-2330
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-2454
  • Fax: 910-671-9303
Mailing address:
  • Phone: 910-738-2454
  • Fax: 910-671-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWIN L BAKER III
Title or Position: OFFICER
Credential: MD
Phone: 910-738-2454