Provider Demographics
NPI:1992028526
Name:GLADE RUN MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES
Other - Org Name:ARMSTRONG PRIMARY CARE CENTER - KITTANNING
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-543-8618
Mailing Address - Street 1:100 MEDICAL ARTS BLDG
Mailing Address - Street 2:STE 150
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7135
Mailing Address - Country:US
Mailing Address - Phone:724-543-5919
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL ARTS BLDG
Practice Address - Street 2:STE 150
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7135
Practice Address - Country:US
Practice Address - Phone:724-543-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLADE RUN MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-10
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty