Organization
WALLOWA MOUNTAIN MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE D. PACE (OFFICE MANAGER)
(541) 432-0197
Entity
Organization
Contact information
Practice address
100 NORTH EAST STREET, JOSEPH, OR 97846-1038
(541) 432-7777
(541) 432-7170
Mailing address
PO BOX 1038, 100 N. EAST STREET, JOSEPH, OR 97846-1038
(541) 432-7777
(541) 432-7170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD16299
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035670
—
OR
Enumeration date
06/01/2006
Last updated
08/22/2020
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