CENTENNIAL MEDICAL GROUP (NPI# 1598926677) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598926677 |
| Entity Type | Organization |
| Organization Name | CENTENNIAL MEDICAL GROUP |
| Other Organization Name | CENTENNIAL UPRIGHT MRI |
| Practice Address |
4640 W Craig Rd N Las Vegas NV 89032-2743 |
| Mailing Address |
4454 N Decatur Blvd Las Vegas NV 89130-5286 |
| Practice Telephone | 7028391203 |
| Practice Fax Number | 7025070992 |
| Mailing Telephone | 7028391203 |
| Mailing Fax Number | 7025070992 |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2008-06-20 |
| Authorized Official Name | MRS. CARLA SHERWOOD (OPERATIONS DIRECTOR) |
| Authorized Official Telephone | 7028182825 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | MEDICARE P-10 | V103360 | 01 |
| Other Name | Type Code |
|---|---|
| Centennial Upright MRI | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730682642 | Centennial Medical Group | Family Medicine | 1341 Bedford Drive, Melbourne, FL 32940 | 2018-03-16 |
| 1073912010 | Centennial Medical Group | Pediatrics | 2579 Nw Edenbower Blvd, Roseburg, OR 97471-6220 | 2014-08-15 |
| 1265664742 | Centennial Medical Group | Surgery | 2570 Nw Edenbower Blvd, Suite 101, Roseburg, OR 97471-6214 | 2009-08-17 |
| 1497993695 | Centennial Medical Group | Pathology | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2009-01-26 |
| 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 |
| System for Award Management (SAM) Entities | CENTENNIAL MEDICAL GROUP INC | 2700 Stewart Pkwy, Roseburg, OR 97471-1281 |
| Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP NORTH, LLC | 201 Medical Loop Ste 190, Roseburg, OR 97471 |
| Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP WEST, LLC | 201 Medical Loop, Suite 190, Roseburg, OR 97471 |
| Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP, INC. | 201 Medical Loop Suite 190, Roseburg, OR 97471 |
| System for Award Management (SAM) Entities | CENTENNIAL MEDICAL GROUP, P.A. | 8186 Lark Brown Rd Ste 201, Elkridge, MD 21075-6434 |
| Street Address |
4640 W CRAIG RD |
| City | N LAS VEGAS |
| State | NV |
| Zip Code | 89032-2743 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629203575 | Elizabeth Manger Fragoso | Physical Therapist | 4640 W Craig Rd, N Las Vegas, NV 89032-2743 | 2009-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225647290 | Bella Mae Home Care | Home Health | 3438 Midnight Shadows Way, North Las Vegaas, NV 89032 | 2020-07-27 |
| 1083231906 | Betsey Bergquist | Pharmacist | 4040 Martin Luther King Blvd, Ste B, North Las Vegas, NV 89032 | 2020-06-26 |
| 1174144687 | Rosalinda Ross | Technician | 3940 Martin Luther King Blv. #106, N. Lasvegas, NV 89032 | 2020-05-06 |
| 1164055919 | Shanae Ebony Glass | Case Manager/Care Coordinator | 2580 North Rancho, Suite 105-106, North Las Vegas, NV 89032 | 2020-02-20 |
| 1912539347 | Roderick Robbins II | Technician | 3940 N. Martin Luther King Blvd B106, N. Las Vegas, NV 89032 | 2020-02-04 |
| 1578103289 | Caring Hands Adult Day Service LLC | Day Training, Developmentally Disabled Services | 2580 North Rancho Dr, Suite 100, North Las Vegas, NV 89032 | 2020-01-10 |
| 1497397830 | Meagan Elizabeth Hill | Nurse Practitioner | 4060 N Martin Luther King Blvd Ste 101-a, Las Vegas, NV 89032 | 2019-10-16 |
| 1386294106 | Amy Nguyen Optometric Professional Corporation | Optometrist | 4080 N Martin Luther King Blvd, North Las Vegas, NV 89032 | 2019-09-13 |
| 1063060978 | Kathy K Cruz Anderson | Technician | 3940 North Martin Luther King Blvd Suite 106, Las Vegas, NV 89032 | 2019-09-04 |
| 1770131625 | Daniel R Thomas | Technician | 3940 N. Martin Luther King Blvd 106, North Las Vegas, NV 89032 | 2019-09-03 |
| Find all providers in zip 89032 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265071039 | Dimuro Facilities Services | Pain Medicine | Dimuro Pain Management, 3970 W Ann Road Ste 100, N Las Vegas, NV 89031 | 2019-12-27 |
| 1083253843 | Dimuro Professional Services LLC | Pain Medicine | Dimuro Pain Management, 3970 W Ann Rd Ste 100, N Las Vegas, NV 89031 | 2019-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689295537 | Regenerative Cell Institute | Pain Medicine | 2911 N Tenaya Way Ste 200, Las Vegas, NV 89128-0495 | 2020-05-01 |
| 1528573292 | Caf Medical LLC | Pain Medicine | 3061 S Maryland Pkwy Ste 103, Las Vegas, NV 89109-6226 | 2017-12-04 |
| 1871044636 | Albert Khavkin, Ltd | Pain Medicine | 9329 Eagle Ridge Dr, Las Vegas, NV 89134 | 2016-10-17 |
| 1326423377 | Advanced Medical Professionals LLC | Pain Medicine | 1151 S Buffalo Dr, Suite 130, Las Vegas, NV 89117-8313 | 2015-07-20 |
| 1982018206 | Jeffrey Zollinger D O PC | Pain Medicine | 343 Elm St Ste 308, Reno, NV 89503-4540 | 2014-06-14 |
| 1568493120 | Robert Bien | Pain Medicine | 7050 Smoke Ranch Rd, Suite 130, Las Vegas, NV 89128 | 2006-07-05 |
| 1215977038 | Walter M Kidwell | Pain Medicine | 7435 W Azure Dr Ste 190, Las Vegas, NV 89130-4427 | 2006-06-08 |
| 1144298928 | Daniel Lewis Burkhead | Pain Medicine | 9920 W Cheyenne Ave, Ste 110, Las Vegas, NV 89129-7725 | 2006-03-09 |
| 1083251250 | Rosemarie Salacup Lizardo | Pain Medicine | 4454 N Decatur Blvd, Las Vegas, NV 89130-5286 | 2019-12-05 |
| 1073169454 | Katriella Fernandez | Pain Medicine | 3975 S Durango Dr Ste 107, Las Vegas, NV 89147-4156 | 2019-08-12 |
| Find all providers with the same taxonomy | ||||
| City | N LAS VEGAS |
| Zip Code | 89032 |
Please comment or provide details below to improve the information on CENTENNIAL MEDICAL GROUP.
| 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.