Organization
CENTENNIAL MEDICAL GROUP EAST, LLC
Active
Parent organization
CENTENNIAL MEDICAL GROUP, INC.
Other names
Evergreen Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTENNIAL MEDICAL GROUP, INC.
Authorized official
DR. JASON GRAY MD (PRESIDENT)
(541) 677-2494
Entity
Organization
Contact information
Practice address
2570 NW EDENBOWER BLVD, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3309
Mailing address
2570 NW EDENBOWER BLVD, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3309
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/02/2011
Last updated
02/06/2013
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