Healthcare Provider Details

I. General information

NPI: 1972296580
Provider Name (Legal Business Name): WOMEN'S HEALTH SERVICES OF ROARING SPRING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

878 PINE HEIGHTS ST
ROARING SPRING PA
16673-2105
US

IV. Provider business mailing address

878 PINE HEIGHTS ST
ROARING SPRING PA
16673-2105
US

V. Phone/Fax

Practice location:
  • Phone: 814-710-8140
  • Fax: 814-224-2397
Mailing address:
  • Phone: 814-710-8140
  • Fax: 814-224-2397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN JOHN BISACCO
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 814-710-8140