NPIMap

Organization Active NPI

Mount Nittany Medical Center

  • Clinical Medical Laboratory
  • State College, PA
National Provider Identifier
1720917933
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MOUNT NITTANY MEDICAL CENTER
Practice address
143 Hospital Dr Ste 205
State College, PA 16803-5500
Phone
(814) 231-6804
Fax
(814) 231-7098
NPI assigned
May 14, 2026
Last updated
May 14, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNT NITTANY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bryan Roach
Title
Cfo
Phone
(814) 234-6148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

143 Hospital Dr Ste 205
State College, PA 16803-5500

Mailing address

155 Wellness Way
State College, PA 16803-6797
Phone (814) 231-7100

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0903220Mount Nittany Physician Group Im143 Hospital Drive, State College, PA 16803Certificate of waiverApr 7, 2027
39D1008518Psu Occupational Medicine143 Hospital Drive, Suite 310, State College, PA 16803Certificate of waiverJan 21, 2027
39D1050072Penn State Orthopaedics and Sports Medicine Ctr143 Hospital Dr, Ste 112, State College, PA 16803Certificate of waiverJan 24, 2028
39D2131677Mount Nittany Park Ave Laboratory143 Hospital Drive, State College, PA 16803Certificate of waiverJun 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pap Smears Centre Comm21 organizations share this tax ID, including this one
Part of
Pap Smears Centre Comm

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1778716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778716800000",
    "number": "1720917933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WELLNESS WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036797",
            "telephone_number": "814-231-7100",
            "fax_number": "814-238-0790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 HOSPITAL DR STE 205",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168035500",
            "telephone_number": "814-231-6804",
            "fax_number": "814-231-7098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT NITTANY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT NITTANY MEDICAL CENTER",
        "enumeration_date": "2026-05-14",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-234-6148"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.