Organization
CENTENNIAL MEDICAL GROUP EAST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM TYREE (COO)
(541) 229-3332
Entity
Organization
Contact information
Practice address
1937 W HARVARD AVE, ROSEBURG, OR 97471-2720
(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
MD12182
OR
261QR1300X
Rural Health Clinic/Center
Primary
38-3896
OR
Other
Enumeration date
09/23/2016
Last updated
05/01/2020
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