# CENTENNIAL MEDICAL GROUP EAST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTENNIAL MEDICAL GROUP, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1134436637
- **Legal business name:** CENTENNIAL MEDICAL GROUP, INC.
- **Authorized official:** KIMBERLY TYREE (COO)
- **Authorized official phone:** (541) 229-3332

## Contact information

- **Practice address:** 2570 NW EDENBOWER BLVD, ROSEBURG, OR 97471-6214
- **Practice address phone:** (541) 677-2494
- **Practice address fax:** (541) 677-2294
- **Mailing address:** 2570 NW EDENBOWER BLVD, ROSEBURG, OR 97471-6214
- **Mailing address phone:** (541) 677-7200
- **Mailing address fax:** (541) 677-7200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | 71216890 | OR | — |
| 207Q00000X | Family Medicine Physician | 71216890 | OR | Yes |
| 363A00000X | Physician Assistant | 71216890 | OR | — |

## Other

- **Enumeration date:** 09/03/2010
- **Last updated:** 07/01/2025