# MOUNT NITTANY MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528321015
- **Authorized official:** BRYAN ROACH (CFO)
- **Authorized official phone:** (814) 234-6184

## Contact information

- **Practice address:** 155 WELLNESS WAY, STATE COLLEGE, PA 16803-6797
- **Practice address phone:** (814) 231-7168
- **Practice address fax:** (814) 235-7381
- **Mailing address:** PO BOX 411847, BOSTON, MA 02241-1834
- **Mailing address phone:** (814) 234-6199
- **Mailing address fax:** (814) 235-7843

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 06/19/2012
- **Last updated:** 07/07/2026