CENTENNIAL MEDICAL GROUP EAST, LLC (NPI# 1235688805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235688805 |
| Entity Type | Organization |
| Organization Name | CENTENNIAL MEDICAL GROUP EAST, LLC |
| Practice Address |
1937 W Harvard Ave Roseburg OR 97471-2720 |
| Mailing Address |
2570 Nw Edenbower Blvd Ste 100 Roseburg OR 97471-6214 |
| Practice Telephone | 5416777200 |
| Practice Fax Number | 5412293309 |
| Mailing Telephone | 5416777200 |
| Mailing Fax Number | 5412293309 |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2020-05-01 |
| Authorized Official Name | KIM TYREE (COO) |
| Authorized Official Telephone | 5412293332 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | MD12182 | OR | Allopathic & Osteopathic Physicians |
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
38-3896 | OR | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083113245 | Centennial Medical Group East, LLC | Family Medicine | 2510 Nw Edenbower Blvd Ste 152, Roseburg, OR 97471-8899 | 2018-02-02 |
| 1992183859 | Centennial Medical Group East, LLC | Clinic/Center | 145 E. Broadway, Myrtle Creek, OR 97457 | 2015-05-12 |
| 1699103598 | Centennial Medical Group East, LLC | Family Medicine | 145 Ne Broadway St, Myrtle Creek, OR 97457-9039 | 2013-10-31 |
| 1821366071 | Centennial Medical Group East, LLC | Clinic/Center | 2570 Nw Edenbower Blvd, Roseburg, OR 97471-6214 | 2011-12-02 |
| 1164730719 | Centennial Medical Group East, LLC | Emergency Medicine | 2570 Nw Edenbower Blvd, Roseburg, OR 97471-6214 | 2010-09-16 |
| 1134436637 | Centennial Medical Group East, LLC | Emergency Medicine | 2570 Nw Edenbower Blvd, Roseburg, OR 97471-6214 | 2010-09-03 |
| 1134243249 | Centennial Medical Group East, LLC | Obstetrics & Gynecology | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2007-03-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CENTENNIAL MEDICAL GROUP EAST, LLC | 2801 Nw Mercy Dr Ste 340, Roseburg, OR 97471-2348 |
| Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP EAST, LLC | 2570 Nw Edenbower Blvd, Roseburg, OR 97471 |
| Street Address |
1937 W HARVARD AVE |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-2720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689647844 | Timothy J Powell | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2006-02-08 |
| 1639703549 | Stacie L. Hanna | Advanced Practice Midwife | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2020-02-29 |
| 1346777950 | Emmanuel Okenye | Internal Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2017-05-12 |
| 1255866489 | Britain Larson Parrish | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2017-04-25 |
| 1295269082 | Anca M Dauer | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2017-04-18 |
| 1376936732 | Pamela Anderson | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2015-03-10 |
| 1760894760 | Elizabeth C Oler | Obstetrics & Gynecology | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2014-05-24 |
| 1578725982 | Cynthia D Kusler | Nurse Practitioner | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2008-06-26 |
| 1174700934 | Matthew T Stark | Physician Assistant | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2008-01-23 |
| 1134243249 | Centennial Medical Group East, LLC | Obstetrics & Gynecology | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2007-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1053854208 | Icco LLC | Clinic/Center | 1740 Nw Goetz Street, Roseburg, OR 97471 | 2016-11-21 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
| Find all providers in zip 97471 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174066278 | Umpqua Health Newton Creek, LLC | Clinic/Center | 3031 Ne Stephens St, Roseburg, OR 97470 | 2016-11-22 |
| 1821366071 | Centennial Medical Group East, LLC | Clinic/Center | 2570 Nw Edenbower Blvd, Roseburg, OR 97471-6214 | 2011-12-02 |
| 1659519171 | Umpqua Health - Harvard, LLC | Clinic/Center | 1813 W Harvard Ave, Suite 201, Roseburg, OR 97471-2754 | 2009-01-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183063 | Praxis Medical Group P.C. | Clinic/Center | 1890 7th St., Umatilla, OR 97882 | 2020-10-27 |
| 1336749621 | Praxis Medical Group P.C. | Clinic/Center | 2011 Fourth St., La Grande, OR 97850 | 2020-10-27 |
| 1225694706 | Columbia Lutheran Charities | Clinic/Center | 1111 N Roosevelt Dr Ste 210, Seaside, OR 97138-4604 | 2019-05-10 |
| 1093296519 | Grande Ronde Hospital, Inc. | Clinic/Center | 10303 S Walton Rd, La Grande, OR 97850 | 2018-08-23 |
| 1285164921 | Northwest Medical Foundation of Tillamook | Clinic/Center | 1005 Cougar St, Vernonia, OR 97064-1282 | 2017-06-15 |
| 1043694342 | Grande Ronde Hospital, Inc | Clinic/Center | 570 8th, Elgin, OR 97827 | 2015-07-16 |
| 1992183859 | Centennial Medical Group East, LLC | Clinic/Center | 145 E. Broadway, Myrtle Creek, OR 97457 | 2015-05-12 |
| 1477945517 | Morrow County Health District | Clinic/Center | 365 W 3rd St, Ione, OR 97843-7216 | 2015-02-26 |
| 1699183236 | Lake Health District | Clinic/Center | 700 South J St, Lakeview, OR 97630 | 2014-07-28 |
| 1487919783 | Aurora Family Health and Maternity Care Services LLC | Clinic/Center | 21358 Hwy 99e Ne, Aurora, OR 97002 | 2012-07-12 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CENTENNIAL MEDICAL GROUP EAST, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.