Provider Demographics
NPI:1114403037
Name:GLADE RUN MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES, INC.
Other - Org Name:ARMSTRONG BREAST AND SURGICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-543-8670
Mailing Address - Street 1:700 MEDICAL ARTS BLDG STE 710
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7141
Mailing Address - Country:US
Mailing Address - Phone:724-543-8626
Mailing Address - Fax:724-543-8736
Practice Address - Street 1:1 NOLTE DR
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7111
Practice Address - Country:US
Practice Address - Phone:724-545-3588
Practice Address - Fax:724-545-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty