MEDICARE: WOMENS LIFE CENTER OF LUMBERTON, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0224J	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1912977612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS LIFE CENTER OF LUMBERTON, PA

Provider Business Mailing Address
First Line	:	800 OAKRIDGE BLVD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2330
Country	:	US
Telephone Number	:	910-738-2454
Fax Number	:	910-671-9303

Provider Business Practice Location Address
First Line	:	800 OAKRIDGE BLVD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2330
Country	:	US
Telephone Number	:	910-738-2454
Fax Number	:	910-671-9303

Authorized Official
Title or Position	:	OFFICER
Name	:	EDWIN L BAKER III
Credential	:	MD
Telephone Number	:	910-738-2454

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/02/2010

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