{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SMART FORM INC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "100 5TH AVE",
"SecondLineMailingAddress": "SUITE 804",
"MailingAddressCityName": "PITTSBURGH",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15222-1821",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "412-281-9913",
"MailingAddressFaxNumber": "412-281-8074",
"FirstLinePracticeLocationAddress": "100 5TH AVE",
"SecondLinePracticeLocationAddress": "SUITE 804",
"PracticeLocationAddressCityName": "PITTSBURGH",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "412-281-9913",
"PracticeLocationAddressFaxNumber": "412-281-8074",
"EnumerationDate": "08/23/2005",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHURMA",
"AuthorizedOfficialFirstName": "LAURIE",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "GENERAL MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BOC CERTIFIED",
"AuthorizedOfficialTelephoneNumber": "412-281-9913",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}