Provider Demographics
NPI:1255300596
Name:GLENDALE AREA MEDICAL ASSOCIATION, INC
Entity Type:Organization
Organization Name:GLENDALE AREA MEDICAL ASSOCIATION, INC
Other - Org Name:GLENDALE AREA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VINGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-672-5141
Mailing Address - Street 1:850 MAIN STREET
Mailing Address - Street 2:P.O. BOX 375
Mailing Address - City:COALPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16627-0375
Mailing Address - Country:US
Mailing Address - Phone:814-672-5141
Mailing Address - Fax:814-672-5461
Practice Address - Street 1:850 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COALPORT
Practice Address - State:PA
Practice Address - Zip Code:16627-0375
Practice Address - Country:US
Practice Address - Phone:814-672-5141
Practice Address - Fax:814-672-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACA 1965OtherRAILROAD MEDICARE
PA391822OtherMEDICARE
PA391822OtherMEDICARE