# CENTENNIAL MEDICAL GROUP WEST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTENNIAL MEDICAL GROUP, INC.
- **Other names:** Centennial Surgical Assistants
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063710192
- **Legal business name:** CENTENNIAL MEDICAL GROUP, INC.
- **Authorized official:** RAHUL AGARWAL (PRESIDENT)
- **Authorized official phone:** (541) 677-2494

## Contact information

- **Practice address:** 2700 NW STEWART PKWY, ROSEBURG, OR 97471-1281
- **Practice address phone:** (541) 677-2494
- **Practice address fax:** (541) 677-2294
- **Mailing address:** 2801 NW MERCY DR STE 340, ROSEBURG, OR 97471-2348
- **Mailing address phone:** (541) 677-2494
- **Mailing address fax:** (541) 677-2294

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2011
- **Last updated:** 03/15/2011