THE WALLACE MEDICAL CONCERN NPI 1841592110

NPI Information

  • NPI: 1841592110
  • Provider Name: THE WALLACE MEDICAL CONCERN
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • Doing Business As: WALLACE
  • CLIA Number: 38D0690059
  • Address: 18633 SE STARK ST STE 401
    PORTLAND, OR
    ZIP 97233
  • Phone: (503) 489-1760

Map and Directions

Get Directions

NPI Details

THE WALLACE MEDICAL CONCERN is a federally qualified health center (fqhc) clinic center in Portland, OR. THE WALLACE MEDICAL CONCERN NPI is 1841592110. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Wallace.

The provider's business location address is:

18633 SE STARK ST STE 401
PORTLAND, OR
ZIP 97233-468
Phone: (503) 489-1760
Fax: (503) 489-1763

The provider's authorized official is Lisa A. Cline .
The authorized official title is Chief Executive Officer and has the following contact phone number (503) 489-1760.

The CLIA number assigned to this NPI record is 38D0690059 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/18/2010 and was last updated on 2/24/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1122300000XDentistNo
2124Q00000XDental HygienistNo
3207Q00000XFamily MedicineNo
4261QC1500XClinic/CenterCommunity HealthNo
5261QD0000XClinic/CenterDentalNo
6363LF0000XNurse PractitionerFamilyNo
7363LP0808XNurse PractitionerPsychiatric/Mental HealthNo
8261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI