Provider Demographics
NPI:1558727792
Name:GLADE RUN MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES, INC.
Other - Org Name:PAIN MANAGEMENT ASSOCIATES OF ARMSTRONG
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO & VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-543-8500
Mailing Address - Street 1:700 MEDICAL ARTS BLDG
Mailing Address - Street 2:SUITE 710
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7141
Mailing Address - Country:US
Mailing Address - Phone:724-543-8622
Mailing Address - Fax:724-543-8743
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:724-543-8626
Practice Address - Fax:724-543-8736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty