Basic Information
| Provider Information | |||||||||
| NPI: | 1649616921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLADE RUN MEDICAL ASSOCIATES INC | ||||||||
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| OtherOrganizationName: | ADULT MEDICINE ASSOCIATES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MEDICAL ARTS BLDG | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245451288 | ||||||||
| FaxNumber: | 7245457615 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 CAPITOL PARK DR | ||||||||
| Address2: | |||||||||
| City: | SARVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160558102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245435919 | ||||||||
| FaxNumber: | 7245433544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO, VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7245438618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.