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General NPI Number Information
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NPI Number | 1033102330
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Entity Type | Organization
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Legal Business Name | SMART FORM INC
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 5TH AVE SUITE 804
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City | PITTSBURGH
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State | PA
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Zip | 15222-1821
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Country | US
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Telephone | 412-281-9913
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Fax | 412-281-8074
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Provider Business Mailing Address
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Address Line | 100 5TH AVE SUITE 804
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City | PITTSBURGH
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State | PA
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Zip | 15222-1821
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Country | US
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Telephone | 412-281-9913
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Fax | 412-281-8074
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. LAURIE J CHURMA
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Credential | BOC CERTIFIED
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Telephone | 412-281-9913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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