Provider Demographics
NPI:1528102712
Name:NITTANY ANESTHESIA PC
Entity type:Organization
Organization Name:NITTANY ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HULEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-861-2177
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16804-0223
Mailing Address - Country:US
Mailing Address - Phone:814-861-2177
Mailing Address - Fax:814-238-2278
Practice Address - Street 1:101 REGENT CT
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7965
Practice Address - Country:US
Practice Address - Phone:814-231-2102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1338851OtherKEYSTONE HEALTH PLAN CENT
PA1338851OtherBLUE SHIELD
PA991BOtherGEISINGER HEALTH PLAN
PADB8968OtherRAILROAD MEDICARE
PA0018963220001Medicaid
PA03091200OtherCAPITAL BLUE CROSS
PA1338851OtherBLUE SHIELD