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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up