NPIMap

Organization Active NPI

Modern Nose Clinic LLC

  • Otolaryngology Physician
  • Salem, OR
National Provider Identifier
1043874696
Registry record updated Apr 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
MODERN NOSE CLINIC LLC
Practice address
340 Vista Ave SE Ste 100
Salem, OR 97302-4546
Phone
(503) 584-1174
Fax
(503) 584-1330
NPI assigned
Apr 30, 2019
Organization subpart
Yes
Parent organization
MODERN NOSE CLINIC LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 30, 2019

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

Authorized official

Name
Dr. Douglas SkaradaNPI 1770588949
Title
Medical Director
Phone
(503) 584-1174

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

340 Vista Ave SE Ste 100
Salem, OR 97302-4546

Mailing address

340 Vista Ave SE Ste 100
Salem, OR 97302-4546
Phone (503) 584-1174

Other practice location 1

19150 SW 90th Ave Ste 100
Tualatin, OR 97062-7624
Phone (503) 584-1174

Other names 1

  • Modern Nose Clinic LLC Former legal business name

National Provider Directory

National Provider Directory
Part of
Modern Nose Clinic LLC

Locations

340 Vista Ave SE
Ste 100
Salem, OR 97302
Phone (503) 584-1174

19150 SW 90th Ave
Ste 100
Tualatin, OR 97062
Phone (503) 584-1174

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556582400000",
    "number": "1043874696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 VISTA AVE SE STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024546",
            "telephone_number": "503-584-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 VISTA AVE SE STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024546",
            "telephone_number": "503-584-1174",
            "fax_number": "503-584-1330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19150 SW 90th Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "970627624",
            "country_code": "US",
            "telephone_number": "503-584-1174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MODERN NOSE CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN NOSE CLINIC LLC",
        "enumeration_date": "2019-04-30",
        "last_updated": "2019-04-30",
        "status": "A",
        "authorized_official_last_name": "SKARADA",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-584-1174",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Nose Clinic LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; 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.