Provider Demographics
NPI:1811796170
Name:WOMBS WINDOW JACKSONVILLE
Entity type:Organization
Organization Name:WOMBS WINDOW JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-352-6368
Mailing Address - Street 1:4608 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7634
Mailing Address - Country:US
Mailing Address - Phone:910-352-6368
Mailing Address - Fax:
Practice Address - Street 1:3780 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5236
Practice Address - Country:US
Practice Address - Phone:910-548-9149
Practice Address - Fax:910-685-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty