Provider Demographics
NPI:1942463518
Name:WOMEN'S HEALTH AND LASER CARE
Entity Type:Organization
Organization Name:WOMEN'S HEALTH AND LASER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BISACCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-944-6055
Mailing Address - Street 1:2918 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1917
Mailing Address - Country:US
Mailing Address - Phone:814-944-6055
Mailing Address - Fax:814-944-1912
Practice Address - Street 1:2918 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1917
Practice Address - Country:US
Practice Address - Phone:814-944-6055
Practice Address - Fax:814-944-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021591291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100777132Medicaid