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General NPI Number Information
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NPI Number | 1295111854
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Entity Type | Organization
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Legal Business Name | GLADE RUN MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 1 NOLTE DR
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City | KITTANNING
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State | PA
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Zip | 16201-7111
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Country | US
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Telephone | 724-543-8536
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Fax |
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Provider Business Mailing Address
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Address Line | 700 MEDICAL ARTS BLDG SUITE 710
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City | KITTANNING
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State | PA
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Zip | 16201-7141
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Country | US
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Telephone | 724-543-8536
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Fax |
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Authorized Official
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Title or Position | VP FINANCE AND CFO
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Name | PATRICK C BURNS
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Credential |
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Telephone | 724-543-8618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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