Provider Demographics
NPI:1649422510
Name:GLORIOSO GENERAL PRACTICE, INC.
Entity Type:Organization
Organization Name:GLORIOSO GENERAL PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:GLORIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-699-2730
Mailing Address - Street 1:PO BOX 6480
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0811
Mailing Address - Country:US
Mailing Address - Phone:740-282-2576
Mailing Address - Fax:740-282-2239
Practice Address - Street 1:103 PLAZA DR STE G
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-7729
Practice Address - Country:US
Practice Address - Phone:740-699-2730
Practice Address - Fax:740-699-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPENDINGMedicaid
OHPENDINGMedicaid
PENDINGMedicare PIN
OHG74430Medicare UPIN