Provider Demographics
NPI:1669829156
Name:CLASSIC FIT AND FORMS INC
Entity type:Organization
Organization Name:CLASSIC FIT AND FORMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHURMA
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:412-281-9913
Mailing Address - Street 1:900 5TH AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-4737
Mailing Address - Country:US
Mailing Address - Phone:412-281-9913
Mailing Address - Fax:
Practice Address - Street 1:900 5TH AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-4737
Practice Address - Country:US
Practice Address - Phone:412-281-9913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000008856332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030813640001Medicaid
PA1030813640001Medicaid