# CENTENNIAL MEDICAL GROUP WEST, LLC

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

## Provider details

- **NPI number:** 1245547744
- **Authorized official:** DOUGLAS KLEBE (OFFICER)
- **Authorized official phone:** (541) 677-3650

## Contact information

- **Practice address:** 2801 NW MERCY DR., STE. 340, ROSEBURG, OR 97471
- **Practice address phone:** (541) 677-4319
- **Practice address fax:** (541) 677-2294
- **Mailing address:** 2801 NW MERCY DR., STE. 340, ROSEBURG, OR 97471
- **Mailing address phone:** (541) 677-4319
- **Mailing address fax:** (541) 677-2294

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/03/2010
- **Last updated:** 03/07/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 500626861 | — | OR |