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Organization
CENTENNIAL MEDICAL GROUP EAST, LLC
Active
Organization
CENTENNIAL MEDICAL GROUP EAST, LLC
Active
Parent organization
CENTENNIAL MEDICAL GROUP EAST, LLC
Other names
Evergreen Family Medicine North
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTENNIAL MEDICAL GROUP EAST, LLC
Authorized official
KIMBERLY TYREE (CHIEF OPERATING OFFICER)
(541) 229-3332
Entity
Organization
Contact information
Practice address
249 DAKOTA ST, SUTHERLIN, OR 97479-9908
(541) 677-7200
(541) 229-3309
Mailing address
2570 NW EDENBOWER BLVD STE 100, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3309
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/21/2023
Last updated
03/21/2023
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