Healthcare Provider Details

I. General information

NPI: 1841317237
Provider Name (Legal Business Name): WHITE RIVER HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 GEORGE JACKSON RD
MAUPIN OR
97037-9208
US

IV. Provider business mailing address

PO BOX 219
MAUPIN OR
97037-0219
US

V. Phone/Fax

Practice location:
  • Phone: 541-395-2911
  • Fax: 541-395-2912
Mailing address:
  • Phone: 541-395-2911
  • Fax: 541-395-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17484
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00762
License Number StateOR

VIII. Authorized Official

Name: LINDSAY ROPER
Title or Position: ADMINISTRATOR
Credential:
Phone: 541-395-2911