Organization
CENTENNIAL MEDICAL GROUP EAST, LLC
Active
Parent organization
CENTENNIAL MEDICAL GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTENNIAL MEDICAL GROUP, INC.
Authorized official
KIMBERLY TYREE (COO)
(541) 229-3332
Entity
Organization
Contact information
Practice address
2570 NW EDENBOWER BLVD, ROSEBURG, OR 97471-6214
(541) 677-2494
(541) 677-2294
Mailing address
2570 NW EDENBOWER BLVD, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 677-7200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
71216890
OR
207Q00000X
Family Medicine Physician
Primary
71216890
OR
363A00000X
Physician Assistant
71216890
OR
Other
Enumeration date
09/03/2010
Last updated
07/01/2025
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