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NPI 1104991801

OrganizationActive

Mount Nittany Medical Center

NPI 1104991801 · Pain Clinic/Center · State College, PA

Provider details

NPI number: 1104991801
Entity type: Organization
Primary specialty: Pain Clinic/CenterAmbulatory Health Care Facilities
Authorized official: Bryan Roach, Cfo
License: 550301 (PA)

Practice location

1700 Old Gatesburg Rd Ste 100

State College, PA 16803-2276

Phone: (814) 237-3360

Fax: (814) 231-7098

More PA providers

Mailing address

155 Wellness Way

State College, PA 16803-6702

Registry dates

Enumerated: 2006-11-21
Last updated: 2026-05-14

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Mount Nittany Medical Center — NPI 1104991801, State College, PA | NPI Central