Healthcare Provider Details

I. General information

NPI: 1669301883
Provider Name (Legal Business Name): MOUNT NITTANY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 OLD GATESBURG RD STE 100
STATE COLLEGE PA
16803-2290
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6702
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7277
  • Fax: 814-231-7098
Mailing address:
  • Phone: 814-231-7100
  • Fax: 814-238-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN ROACH
Title or Position: CFO
Credential:
Phone: 814-234-6148