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Organization

CENTENNIAL MEDICAL GROUP NORTH, LLC

Active
Parent organization
CENTENNIAL MEDICAL GROUP, INC.
Organization subpart
Yes

Provider details

NPI number
Legal business name
CENTENNIAL MEDICAL GROUP, INC.
Authorized official
RAHUL AGARWAL (PRESIDENT)
(541) 677-2494
Entity
Organization

Contact information

Practice address
2801 NW MERCY DR STE 340, ROSEBURG, OR 97471-2348
(541) 677-2494
(541) 677-2294
Mailing address
2801 NW MERCY DR STE 340, ROSEBURG, OR 97471-2348
(541) 677-2494
(541) 677-2294

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
207XS0117X
Orthopaedic Surgery of the Spine Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500630863
OR
Enumeration date
10/21/2010
Last updated
05/16/2012
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