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MOUNT NITTANY MEDICAL CENTER
NPI 1104991801
Clinic/Center - Pain in State College, PA

Active since November 21, 2006CLIA Certified · 2 labs
1700 OLD GATESBURG RD STE 100, STATE COLLEGE, PA 16803(814) 237-3360(814) 231-7098 Get Directions Write a Review

NPPES record last updated: May 14, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 14, 2026, Apr 10, 2025, Oct 14, 2021 (3 updates tracked since 2021).

About Mount Nittany Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUNT NITTANY MEDICAL CENTER (NPI 1104991801), doing business as Mount Nittany Pain Center, is a healthcare organization registered as a pain in State College, Pennsylvania and active in the NPI registry since November 2006. The organization holds 2 active CLIA laboratory certificates and lists Bryan Roach, Cfo, as its authorized official.

NPPES Registry Identity

NPI1104991801
Entity TypeOrganization
Primary Taxonomy261QP3300X
Legal Business NameMOUNT NITTANY MEDICAL CENTER
Location Address1700 OLD GATESBURG RD STE 100State College, PA 16803-2276
Mailing Address155 Wellness WayState College, PA 16803-6702 · (814) 234-6181 · Fax (814) 238-5185
Phone(814) 237-3360
Fax(814) 231-7098
Organization SubpartNo
Authorized OfficialBryan RoachCfo · (814) 234-6148
Enumeration DateNovember 21, 2006
Last NPPES UpdateMay 14, 20263 updates tracked since enumeration
NPPES CertifiedMay 14, 2026
✔ NPI 1104991801 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · PainAmbulatory Health Care Facilities
Taxonomy Code261QP3300X
License✔ Licensed in PA · 550301
1700 OLD GATESBURG RD STE 100, State College, PA 16803
Open in Google Maps ↗

Other Names 1

Doing Business AsMount Nittany Pain Center

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 39D2334736

Mount Nittany Medical Center · State College, PA
Active · expires Nov 30, 2027
CLIA Number39D2334736
Laboratory TypeHospital
Certificate Effective DateDecember 1, 2025
Certificate Expiration DateNovember 30, 2027
Laboratory DirectorDr. Shreya M. Patel
Laboratory Phone(814) 234-6125
Laboratory LocationMount Nittany Medical Center155 Wellness Way, Labor And Delivery, State College, PA 16803
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Waiver 39D2159483

Mount Nittany Medical Center Blue Course · State College, PA
Active · expires Dec 18, 2026
CLIA Number39D2159483
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateDecember 19, 2024
Certificate Expiration DateDecember 18, 2026
Laboratory DirectorDr. Jacob M. Alexander
Laboratory Phone(814) 278-4698
Laboratory LocationMount Nittany Medical Center Blue Course1700 Old Galesburg Road, Suite 100, State College, PA 16803
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOUNT NITTANY MEDICAL CENTER
Radiology (Diagnostic Radiology)
1700 OLD GATESBURG RD STE 100
STATE COLLEGE, PA 16803
Centre County (814) 231-7000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mount Nittany Medical Center's NPI number?

The NPI number for Mount Nittany Medical Center is 1104991801. It was assigned to this organization in the NPPES registry on November 21, 2006. The provider is doing business as Mount Nittany Pain Center.

Where is Mount Nittany Medical Center located?

Mount Nittany Medical Center is located at 1700 Old Gatesburg Rd Ste 100, State College, PA 16803. The listed phone number is (814) 237-3360.

What is Mount Nittany Medical Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Pain, with taxonomy code 261QP3300X.

Does Mount Nittany Medical Center hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Mount Nittany Medical Center was last updated on May 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.