THE WALLACE MEDICAL CONCERN
NPI 1215390109
Nurse Practitioner - Family in Gresham, OR

Q: What is The Wallace Medical Concern's NPI number?

The NPI number for The Wallace Medical Concern is 1215390109. It was assigned to this organization in the NPPES registry on March 30, 2016.

Q: What is The Wallace Medical Concern's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since March 30, 2016

254 NW BURNSIDE ROAD, GRESHAM, OR 97030(503) 489-1760 Get Directions Write a Review

NPPES record last updated: March 30, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About The Wallace Medical Concern NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THE WALLACE MEDICAL CONCERN (NPI 1215390109) is a healthcare organization registered as a family in Gresham, Oregon and active in the NPI registry since March 2016. The organization lists William Roller, Operations Director, as its authorized official.

NPPES Registry Identity

NPI1215390109

Entity TypeOrganization

Primary Taxonomy363LF0000X

Legal Business NameTHE WALLACE MEDICAL CONCERN

Location Address254 NW BURNSIDE ROADGresham, OR 97030

Mailing Address254 Nw Burnside RoadGresham, OR 97030

Phone(503) 489-1760

Organization SubpartNo

Authorized OfficialWilliam RollerOperations Director · (503) 489-1760

Enumeration DateMarch 30, 2016

✔ NPI 1215390109 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

254 NW BURNSIDE ROAD, Gresham, OR 97030

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is The Wallace Medical Concern's NPI number?

The NPI number for The Wallace Medical Concern is 1215390109. It was assigned to this organization in the NPPES registry on March 30, 2016.

Where is The Wallace Medical Concern located?

The Wallace Medical Concern is located at 254 NW Burnside Road, Gresham, OR 97030. The listed phone number is (503) 489-1760.

What is The Wallace Medical Concern's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for The Wallace Medical Concern was last updated on March 30, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.