Salem Medical Massage, LLC

Key facts

NPI

1215488671

Entity type

Organization (NPI type 2)

Primary specialty

Health Maintenance Organization 302R00000X

License

18560 (OR)

Legal business name

SALEM MEDICAL MASSAGE, LLC

Practice address

249 Liberty St NE # B60
Salem, OR 97301-3503

Phone

(503) 877-7389

NPI assigned

Oct 20, 2016

Organization subpart

No

Authorized official

Name

Blake Garrett Dunham

Title

Owner

Phone

(503) 877-7389

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 18, 2017.

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487376000000",
    "number": "1215488671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 LIBERTY ST. NE #B60",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97301",
            "telephone_number": "503-877-7389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 LIBERTY ST NE # B60",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013503",
            "telephone_number": "503-877-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM MEDICAL MASSAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-20",
        "last_updated": "2017-02-18",
        "status": "A",
        "authorized_official_last_name": "DUNHAM",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "GARRETT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-877-7389"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "OR",
            "license": "18560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Salem, OR · Health Maintenance Organization in Oregon