Provider Demographics
NPI:1962828574
Name:GLADE RUN MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES INC
Other - Org Name:ARMSTRONG NEUROLOGY ASSOCIATES
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 1:500 MEDICAL ARTS BLDG
Mailing Address - Street 2:SUITE 510
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7137
Mailing Address - Country:US
Mailing Address - Phone:724-543-8014
Mailing Address - Fax:724-543-8015
Practice Address - Street 1:500 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 510
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7137
Practice Address - Country:US
Practice Address - Phone:724-543-8014
Practice Address - Fax:724-543-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183797Medicare PIN