Provider Demographics
NPI:1992195549
Name:GLADE RUN MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES INC
Other - Org Name:SOTOS ORTHOPEDICS
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:724-543-8618
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:724-543-8624
Mailing Address - Fax:724-543-8736
Practice Address - Street 1:600 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 660
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7134
Practice Address - Country:US
Practice Address - Phone:724-543-9087
Practice Address - Fax:724-543-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty