MODERN NOSE CLINIC LLC (NPI# 1043874696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043874696 |
| Entity Type | Organization |
| Organization Name | MODERN NOSE CLINIC LLC |
| Practice Address |
340 Vista Ave Se Ste 100 Salem OR 97302-4546 |
| Practice Telephone | 5035841174 |
| Practice Fax Number | 5035841330 |
| Mailing Telephone | 5035841174 |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |
| Authorized Official Name | DR. DOUGLAS SKARADA (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 5035841174 |
| Is Organization Subpart | Y |
| Parent Organization Name | MODERN NOSE CLINIC LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Modern Nose Clinic LLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 19150 Sw 90th Ave Ste 100, Tualatin, OR 970627624 | 5035841174 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MODERN NOSE CLINIC LLC | 340 Vista Avenue #100, Salem, OR 97302 |
| Street Address |
340 VISTA AVE SE STE 100 |
| City | SALEM |
| State | OR |
| Zip Code | 97302-4546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770588949 | Douglas Skarada | Otolaryngology | 340 Vista Ave Se Ste 100, Salem, OR 97302-4546 | 2005-06-15 |
| 1629224365 | Nahmjee Lee Skarada | Dentist | 340 Vista Ave Se Ste 100, Salem, OR 97302-4546 | 2008-08-13 |
| 1386654333 | Holli J Christensen | Audiologist | 340 Vista Ave Se Ste 100, Salem, OR 97302-4546 | 2006-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
| 1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
| 1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
| 1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
| 1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
| 1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
| Find all providers in zip 97302 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1013286822 | Lawrence Thomas Eschelman | Otolaryngology | 3585 Cherokee Dr S, Salem, OR 97302-9712 | 2011-12-22 |
| 1538462189 | Jon Bruce Hagadorn | Otolaryngology | 3136 W Club Dr, Salem, VA 24153-6823 | 2010-12-20 |
| 1093821969 | Masud Iqbal | Otolaryngology | 156 Route 45, Salem, NJ 08079 | 2006-08-22 |
| 1003889866 | Charles J. Leidner | Otolaryngology | 55 Highland Avuene, Suite 201, Salem, MA 01970 | 2006-02-10 |
| 1851377857 | Charles David Crouse II | Otolaryngology | 1524 Apperson Dr, Salem, VA 24153-7219 | 2005-12-21 |
| 1770588949 | Douglas Skarada | Otolaryngology | 340 Vista Ave Se Ste 100, Salem, OR 97302-4546 | 2005-06-15 |
| 1407850852 | John Donovan | Otolaryngology | 3099 River Rd S, Salem, OR 97302-9754 | 2005-06-13 |
| 1013278654 | Jared Hiebert | Otolaryngology | 3099 River Rd S Ste 150, Salem, OR 97302-9754 | 2012-05-30 |
| 1184956765 | Roanoke Valley Ear, Nose, and Throat, P.C. | Otolaryngology | 1524 Apperson Dr, Salem, VA 24153-7219 | 2010-02-05 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.