Provider Demographics
NPI:1467722462
Name:GLADE RUN MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES, INC
Other - Org Name:SARVER INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:724-543-8618
Mailing Address - Street 1:112 CAPITOL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-8102
Mailing Address - Country:US
Mailing Address - Phone:724-719-9300
Mailing Address - Fax:724-294-9488
Practice Address - Street 1:700 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 710
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7141
Practice Address - Country:US
Practice Address - Phone:724-543-8624
Practice Address - Fax:724-543-8736
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLADE RUN MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1881820850OtherGROUP NPI