Organization
CENTENNIAL MEDICAL GROUP EAST, LLC
Active
Parent organization
CENTENNIAL MEDICAL GROUP DBA EVERGREEN FAMILY MEDICINE SOUTH
Other names
Evergreen Family Medicine South
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTENNIAL MEDICAL GROUP DBA EVERGREEN FAMILY MEDICINE SOUTH
Authorized official
KIM TYREE (COO)
(541) 229-3332
Entity
Organization
Contact information
Practice address
145 NE BROADWAY ST, MYRTLE CREEK, OR 97457-9039
(541) 863-3146
(541) 863-3226
Mailing address
2801 NW MERCY DR, SUITE 340, ROSEBURG, OR 97471-2348
(541) 677-2494
(541) 677-2294
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
71216890
OR
207Q00000X
Family Medicine Physician
—
OR
261QR1300X
Rural Health Clinic/Center
Primary
—
OR
Other
Enumeration date
10/31/2013
Last updated
11/22/2016
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