Provider Demographics
NPI:1295111854
Name:GLADE RUN MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
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:724-543-8536
Mailing Address - Fax:
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:724-543-8536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty