Provider Demographics
NPI:1326673690
Name:GLADE RUN MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:GLADE RUN MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-543-8500
Mailing Address - Street 1:1 NOLTE DR
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7111
Mailing Address - Country:US
Mailing Address - Phone:724-543-8500
Mailing Address - Fax:724-543-8616
Practice Address - Street 1:600 MEDICAL ARTS BLDG STE 660
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7110
Practice Address - Country:US
Practice Address - Phone:724-548-3884
Practice Address - Fax:724-548-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-07
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty