Healthcare Provider Details

I. General information

NPI: 1700027927
Provider Name (Legal Business Name): CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 KOT NUM ROAD
WARM SPRINGS OR
97761-3001
US

IV. Provider business mailing address

PO BOX C
WARM SPRINGS OR
97761-3001
US

V. Phone/Fax

Practice location:
  • Phone: 541-553-1196
  • Fax: 541-553-2476
Mailing address:
  • Phone: 541-553-3205
  • Fax: 541-553-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOSEPH COLLINS
Title or Position: MANAGED CARE DIRECTOR
Credential:
Phone: 541-553-2494