Silver Falls Dermatology, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SILVER FALLS DERMATOLOGY, LLC

Practice address

1793 13TH St SE
Salem, OR 97302-2541

Phone

(503) 362-8385

Fax

(503) 362-8435

NPI assigned

Apr 28, 2010

Organization subpart

No

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

Authorized official

Name

Malissa Kobbevik

Title

Credentialing Manager

Phone

(360) 375-2038

Specialties & licenses 3

Addresses

Other names 1

• FRONTIER DERMATOLOGY Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Frontier Dermatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Silver Falls Dermatology, LLC

  • Ambulatory Surgical Clinic/Center
  • Seattle, WA
  • NPI 1417163635
  NPD tax ID

Locations

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1770800930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1793 13TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022541",
            "telephone_number": "503-362-8385",
            "fax_number": "503-362-8435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1793 13TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022541",
            "telephone_number": "503-362-8385",
            "fax_number": "503-362-8435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER FALLS DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "KOBBEVIK",
        "authorized_official_first_name": "MALISSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "360-375-2038"
    },
    "taxonomies": [
        {
            "code": "207KI0005X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FRONTIER DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle Silbernagel
• Veronica Silva-Quiroz, QMHA
• Jaime Silva, LPC, CRC, CADC 1
• Silver Creek Retirement & Assisted Living Community LLC
• Silver Falls Dermatology, LLC
• Silver Falls Trauma Recovery LLC
• Silver Linings Senior Care Advisors LLC
• Linda Silvestre
• Debra Ellen Simeral, LMT
• Dee A Simmons, CADC I

• Clinical Medical Laboratory in Salem, OR
• Providers in Salem, OR by specialty
• Clinical Medical Laboratory in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.