THE WALLACE MEDICAL CONCERN (NPI# 1841592110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841592110 |
| Entity Type | Organization |
| Organization Name | THE WALLACE MEDICAL CONCERN |
| Other Organization Name | WALLACE MEDICAL CONCERN |
| Practice Address |
124 Ne 181st Ave Suite 120 Portland OR 97230 |
| Mailing Address |
124 Ne 181st Ave. Suite 103 Portland OR 97230 |
| Practice Telephone | 5034891760 |
| Practice Fax Number | 5034891763 |
| Mailing Telephone | 5034891760 |
| Mailing Fax Number | 5034891763 |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2017-01-26 |
| Authorized Official Name | MS. LISA A. CLINE (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 5034891760 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Wallace Medical Concern | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | THE WALLACE MEDICAL CONCERN | 124 Ne 181st Ave, Suite 103, Portland, OR 97230 |
| Street Address |
124 NE 181ST AVE SUITE 120 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063433365 | Thomas S Stewart | Nurse Practitioner | 124 Ne 181st Ave, Suite 103, Portland, OR 97230-6668 | 2006-07-21 |
| 1124496112 | Sarah Chaney Campbell | Social Worker | 124 Ne 181st Ave, Portland, OR 97230-6668 | 2015-09-08 |
| 1215346929 | Katherine Bucciantini | Nurse Practitioner | 124 Ne 181st Ave, Suite 103, Portland, OR 97230-6668 | 2014-08-06 |
| 1649373424 | Anna Jimenez | Family Medicine | 124 Ne 181st Ave, Suite 103, Portland, OR 97230-6668 | 2006-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687233 | Timisha K Wilson | Social Worker | 12505 Ne Halsey St, Portland, OR 97230 | 2018-07-30 |
| 1356828768 | Sally Gail Logan | Pharmacist | 5725 Ne 138th Avenue, Portland, OR 97230 | 2018-07-27 |
| 1063937951 | Marley Elizabeth Small | Counselor | 1507 Ne 122nd Ave., Portland, OR 97230 | 2017-08-11 |
| 1447771316 | Shadab Nasreen Aijazi | Pathology | 5220 Ne 122nd Avenue, Portland, OR 97230 | 2017-06-30 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
| 1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
| 1649622473 | Sara Mcgroarty | Counselor | 17710 Ne Halsey Street, Portland, OR 97230 | 2016-07-05 |
| 1346699949 | Steven D Stanton | Counselor | 1022 Ne 181st Ave, C1, Portland, OR 97230 | 2016-06-06 |
| 1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
| Find all providers in zip 97230 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679047872 | Portland Community Health Center | Clinic/Center | 52 Frederic St, Portland, ME 04102-2700 | 2019-01-22 |
| 1043783822 | Portland Community Health Center | Clinic/Center | 72 Bishop St, Portland, ME 04102-2957 | 2019-01-04 |
| 1770056558 | Portland Community Health Center | Clinic/Center | 190 Valley Street, Portland, ME 04102-2957 | 2019-01-04 |
| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1700317971 | Portland Community Health Center | Clinic/Center | 28 Portland St, Portland, ME 04101-2912 | 2017-03-21 |
| 1255872537 | Portland Community Health Center | Clinic/Center | 175 Auburn St, Portland, ME 04103-2131 | 2017-03-20 |
| 1477005619 | Outside In | Clinic/Center | 1226 Sw 12th Ave, Portland, OR 97205-2029 | 2016-11-03 |
| 1649636986 | Mainline Health Systems, Inc | Clinic/Center | 314 Highway 160 E, Portland, AR 71663-9262 | 2015-12-31 |
| 1144691098 | Central City Concern Inc | Clinic/Center | 2566 Ne Hoyt St, Portland, OR 97232-2323 | 2015-10-16 |
| 1295119386 | Central City Concern Inc | Clinic/Center | 12133 E. Burnside St, Portland, OR 97216-2344 | 2015-07-17 |
| Find all providers in PORTLAND | ||||
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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.