Provider Demographics
NPI:1649616921
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:CFO, VP FINANCE
Authorized Official - Prefix:MR
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 1:100 MEDICAL ARTS BLDG
Mailing Address - Street 2:SUITE 150
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7135
Mailing Address - Country:US
Mailing Address - Phone:724-545-1288
Mailing Address - Fax:724-545-7615
Practice Address - Street 1:112 CAPITOL PARK DR
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-8102
Practice Address - Country:US
Practice Address - Phone:724-543-5919
Practice Address - Fax:724-543-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty