Healthcare Provider Details

I. General information

NPI: 1689439283
Provider Name (Legal Business Name): MOUNT NITTANY HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 GREENVIEW DRIVE
STATE COLLEGE PA
16803
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6702
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7000
  • Fax: 814-238-0790
Mailing address:
  • Phone: 814-231-7000
  • Fax: 814-238-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

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