Smart Form Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

SMART FORM INC

Practice address

100 5TH Ave
Suite 804
Pittsburgh, PA 15222-1821

Phone

(412) 281-9913

Fax

(412) 281-8074

NPI assigned

Aug 23, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Laurie J Churma, BOC CERTIFIED

Title

General Manager

Phone

(412) 281-9913

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Smart Foam Corset Shop Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033102330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 5TH AVE",
            "address_2": "SUITE 804",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152221821",
            "telephone_number": "412-281-9913",
            "fax_number": "412-281-8074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 5TH AVE",
            "address_2": "SUITE 804",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152221821",
            "telephone_number": "412-281-9913",
            "fax_number": "412-281-8074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMART FORM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHURMA",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "412-281-9913",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BOC CERTIFIED"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016096020001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smart Foam Corset Shop",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Stefanie Gail Small, LCSW
• Susan Elaine Small, LCSW
• Troy D Small, CRNP
• Kathryn Lynn Smallwood, RN
• Mark A Smallwood, MPT
• Tracey Smart, DO
• Melanie Smartnick, RD,LDN
• Amy Smeal
• David Smeal
• Erica Smedley, MSN, RN

• Prosthetic/Orthotic Supplier in Pittsburgh, PA
• Providers in Pittsburgh, PA by specialty
• Prosthetic/Orthotic Supplier in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.