1467722462 NPI number — GLADE RUN MEDICAL ASSOCIATES, INC

Table of content: (NPI 1467722462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467722462 NPI number — GLADE RUN MEDICAL ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLADE RUN MEDICAL ASSOCIATES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SARVER INTERNAL MEDICINE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467722462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 CAPITOL PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16055-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-719-9300
Provider Business Mailing Address Fax Number:
724-294-9488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 MEDICAL ARTS BLDG
Provider Second Line Business Practice Location Address:
SUITE 710
Provider Business Practice Location Address City Name:
KITTANNING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16201-7141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-543-8624
Provider Business Practice Location Address Fax Number:
724-543-8736
Provider Enumeration Date:
01/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
724-543-8618

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1881820850 . This is a "GROUP NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".