Provider Demographics
NPI:1164691499
Name:MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC
Other - Org Name:PENNS VALLEY AREA MEDICAL CENTER PC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CORPORATE COMPLIANCE AN
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-234-6147
Mailing Address - Street 1:4570 PENNS VALLEY RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SPRING MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16875-8500
Mailing Address - Country:US
Mailing Address - Phone:814-422-8873
Mailing Address - Fax:814-422-8860
Practice Address - Street 1:4570 PENNS VALLEY RD
Practice Address - Street 2:STE 1
Practice Address - City:SPRING MILLS
Practice Address - State:PA
Practice Address - Zip Code:16875-8500
Practice Address - Country:US
Practice Address - Phone:814-422-8873
Practice Address - Fax:814-422-8860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-20
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA568674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty