# WALLOWA MOUNTAIN MEDICAL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356388078
- **Authorized official:** LESLIE D. PACE (OFFICE MANAGER)
- **Authorized official phone:** (541) 432-0197

## Contact information

- **Practice address:** 100 NORTH EAST STREET, JOSEPH, OR 97846-1038
- **Practice address phone:** (541) 432-7777
- **Practice address fax:** (541) 432-7170
- **Mailing address:** PO BOX 1038, 100 N. EAST STREET, JOSEPH, OR 97846-1038
- **Mailing address phone:** (541) 432-7777
- **Mailing address fax:** (541) 432-7170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD16299 | OR | Yes |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 08/22/2020