38D0690059 CLIA NUMBER - WALLACE MEDICAL CONCERN

Laboratory Demographics

  • CLIA Code: 38D0690059
  • Facility Name: WALLACE MEDICAL CONCERN
  • Facility Address: 18633 SE STARK STREET, STE 401
    PORTLAND, OR
    ZIP 97233
  • Facility Phone: 503 489-1760
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. STUART J. CURRIE
  • NPI Number: 1841592110
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D0690059
LAB Type Federally Qualified Health Center
Facility Name WALLACE MEDICAL CONCERN
Street 18633 SE STARK STREET, STE 401
City PORTLAND
State OR
ZIP 97233
Phone 503 489-1760
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2025
Certificate Expiration Date 1/17/2027
Facility Type Federally Qualified Health Center
Lab Director DR. STUART J. CURRIE

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This page was last updated on: 9/29/2025