| Wallowa Mountain Medical | |
|
100 North East Street Joseph OR 97846-1038 | |
| (541) 432-7777 | |
| (541) 432-7170 |
| Full Name | Wallowa Mountain Medical |
|---|---|
| Speciality | Family Medicine |
| Location | 100 North East Street, Joseph, Oregon |
| Authorized Official Name and Position | Leslie D. Pace (OFFICE MANAGER) |
| Authorized Official Contact | 5414320197 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wallowa Mountain Medical Po Box 1038 100 N. East Street Joseph OR 97846-1038 Ph: (541) 432-7777 | Wallowa Mountain Medical 100 North East Street Joseph OR 97846-1038 Ph: (541) 432-7777 |
| NPI Number | 1356388078 |
|---|---|
| Provider Enumeration Date | 06/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356388078 | NPI | - | NPPES |
| 035670 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD16299 (Oregon) | Primary |
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