# CENTENNIAL MEDICAL GROUP EAST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134243249
- **Authorized official:** KIMBERLY TYREE (COO)
- **Authorized official phone:** (541) 229-3332

## Contact information

- **Practice address:** 1937 W HARVARD AVE, ROSEBURG, OR 97471-2720
- **Practice address phone:** (541) 677-7200
- **Practice address fax:** (541) 229-3309
- **Mailing address:** 2570 NW EDENBOWER BLVD, ROSEBURG, OR 97471-6214
- **Mailing address phone:** (541) 677-7200
- **Mailing address fax:** (541) 677-7462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | OR | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 05/01/2020