CENTENNIAL MEDICAL GROUP EAST LLC NPI 1235688805

NPI Information

NPI: 1235688805
Provider Name: CENTENNIAL MEDICAL GROUP EAST, LLC
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
1937 W HARVARD AVE
ROSEBURG, OR
ZIP 97471
Phone: (541) 677-7200
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CENTENNIAL MEDICAL GROUP EAST, LLC is a rural health clinic center in Roseburg, OR. CENTENNIAL MEDICAL GROUP EAST, LLC NPI is 1235688805. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1937 W HARVARD AVE
ROSEBURG, OR
ZIP 97471-720
Phone: (541) 677-7200
Fax: (541) 229-3309

The provider's authorized official is Kim Tyree .
The authorized official title is Coo and has the following contact phone number (541) 229-3332.

The enumeration date for this NPI number is 9/23/2016 and was last updated on 5/1/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		MD12182	OREGON	No
2	261QR1300X	Clinic/Center	Rural Health	38-3896	OREGON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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