Provider Type Icon

CENTENNIAL MEDICAL GROUP WEST LLC NPI 1245547744


NPI Information

NPI: 1245547744
Provider Name: CENTENNIAL MEDICAL GROUP WEST, LLC
Classification: Ophthalmology - 207W00000X
Entity Type: Organization

CLIA Number: 38D2083020

Address:
2801 NW MERCY DR.
STE. 340
ROSEBURG, OR
ZIP 97471
Phone: (541) 677-4319
Get Directions

CENTENNIAL MEDICAL GROUP WEST, LLC is an ophthalmology in Roseburg, OR. The provider is an ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. CENTENNIAL MEDICAL GROUP WEST, LLC NPI is 1245547744. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2801 NW MERCY DR.
STE. 340
ROSEBURG, OR
ZIP 97471
Phone: (541) 677-4319
Fax: (541) 677-2294

The provider's authorized official is Douglas Klebe .
The authorized official title is Officer and has the following contact phone number (541) 677-3650.

The CLIA number assigned to this NPI record is 38D2083020 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/3/2010 and was last updated on 3/7/2017.


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
1207W00000XOphthalmologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1R156684MEDICARE UPINOREGON
2500626861MEDICAIDOREGON

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.