Provider Demographics
NPI:1912977612
Name:WOMENS LIFE CENTER OF LUMBERTON, PA
Entity Type:Organization
Organization Name:WOMENS LIFE CENTER OF LUMBERTON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:910-738-2454
Mailing Address - Street 1:800 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2330
Mailing Address - Country:US
Mailing Address - Phone:910-738-2454
Mailing Address - Fax:910-671-9303
Practice Address - Street 1:800 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2330
Practice Address - Country:US
Practice Address - Phone:910-738-2454
Practice Address - Fax:910-671-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890224JMedicaid
NC0224JOtherBCBS