Healthcare Provider Details

I. General information

NPI: 1326164138
Provider Name (Legal Business Name): THE PA STATE UNIVERSITY-UNIVERSITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 EISENHOWER RD 202C STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802-4601
US

IV. Provider business mailing address

542 EISENHOWER RD 202C STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802-4601
US

V. Phone/Fax

Practice location:
  • Phone: 814-865-9321
  • Fax: 814-863-5371
Mailing address:
  • Phone: 814-865-9321
  • Fax: 814-863-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberHP418150L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier2080921
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier1002707420005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: NATAHSHA BAUMGARTNER
Title or Position: ASST. DIRECTOR OF UHS OPERATIONS
Credential: LSW
Phone: 814-865-3585