Basic Information
| Provider Information | |||||||||
| NPI: | 1114376274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLADE RUN MEDICAL ASSOCIATES | ||||||||
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| OtherOrganizationName: | ARMSTRONG EAR, NOSE, AND THROAT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 MEDICAL ARTS BLDG | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438626 | ||||||||
| FaxNumber: | 7245438736 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 MEDICAL ARTS BLDG | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245435991 | ||||||||
| FaxNumber: | 7245433071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2016 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE / CFO | ||||||||
| AuthorizedOfficialTelephone: | 7245438618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.