Healthcare Provider Details

I. General information

NPI: 1477891711
Provider Name (Legal Business Name): CENTRE COUNTY CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 04/10/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLNESS WAY
STATE COLLEGE PA
16803-6709
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6797
US

V. Phone/Fax

Practice location:
  • Phone: 814-272-4400
  • Fax: 814-231-7295
Mailing address:
  • Phone: 814-272-4400
  • Fax: 814-231-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PETER D. TATE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 814-272-4400