Provider Demographics
NPI:1801119433
Name:GLADE RUN MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:400 MEDICAL ARTS BLDG
Mailing Address - Street 2:STE 410
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7160
Mailing Address - Country:US
Mailing Address - Phone:724-543-4046
Mailing Address - Fax:
Practice Address - Street 1:400 MEDICAL ARTS BLDG
Practice Address - Street 2:STE 410
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7160
Practice Address - Country:US
Practice Address - Phone:724-543-4046
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:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty