Michael Leslie Nichols (NPI# 1568570547, PAC ID# 3779537220) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1568570547 |
| PAC ID by PECOS | 3779537220 |
| Professional Enrollment ID | I20050308000415 |
| Full Name | Michael Leslie Nichols |
| Organization Legal Name | CENTENNIAL MEDICAL GROUP EAST, LLC |
| Address |
2570 Nw Edenbower Blvd Suite 100 Roseburg OR 97471-6214 |
| Phone Number | 5416777200 |
| Gender | M |
| Credential | DO |
| Medical School | COLLEGE OF OSTEO OF THE PACIFIC |
| Graduation Year | 1992 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 9234397878 |
| Number of Group Practice Members | 37 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 380027 | MERCY MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2510 Nw Edenbower Blvd, Suite 152, Roseburg, OR 97471-8899 | 5416777200400 | CENTENNIAL MEDICAL GROUP EAST, LLC |
| 2510 Nw Edenbower Blvd, Roseburg, OR 97471-8899 | 5416777200400 | CENTENNIAL MEDICAL GROUP EAST, LLC |
| 2510 Nw Medical Park Dr, Roseburg, OR 97471-5510 | 5416777200400 | CENTENNIAL MEDICAL GROUP EAST, LLC |
| 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 | 5416777200 | CENTENNIAL MEDICAL GROUP EAST, LLC |
| 2570 Nw Edenbower Blvd, Roseburg, OR 97471-6214 | 5416777200 | CENTENNIAL MEDICAL GROUP EAST, LLC |
| Organization Legal Name | CENTENNIAL MEDICAL GROUP EAST, LLC |
| Physicians | 35 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brandon W Bonds | Family Medicine | Centennial Medical Group East, LLC | 2510 Nw Medical Park Dr, Roseburg, OR 97471-5510 |
| Stefanie Rae Coffey | Nurse Practitioner | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Shelley G Brittain | Family Medicine | Centennial Medical Group East, LLC | 145 Ne Broadway St, Myrtle Creek, OR 97457-9039 |
| Mary E Orians | Nurse Practitioner | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Scott O Goebel | Physician Assistant | Centennial Medical Group East, LLC | 2510 Nw Medical Park Dr, Roseburg, OR 97471-5510 |
| Matthew T Stark | Physician Assistant | Centennial Medical Group East, LLC | 2510 Nw Medical Park Dr, Roseburg, OR 97471-5510 |
| Kristina A Skinner | Nurse Practitioner | Centennial Medical Group East, LLC | 145 Ne Broadway St, Myrtle Creek, OR 97457-9039 |
| Virginia M Hawes | Internal Medicine | Centennial Medical Group East, LLC | 2510 Nw Medical Park Dr, Roseburg, OR 97471-5510 |
| Nicole Engler | Nurse Practitioner | Centennial Medical Group East, LLC | 145 Ne Broadway St, Myrtle Creek, OR 97457-9039 |
| Charles A Musgrave | Physician Assistant | Centennial Medical Group East, LLC | 2510 Nw Medical Park Dr, Roseburg, OR 97471-5510 |
| Street Address |
2570 NW EDENBOWER BLVD SUITE 100 |
| City | ROSEBURG |
| State | OR |
| Zip | 97471-6214 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Stefanie Rae Coffey | Nurse Practitioner | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Mary E Orians | Nurse Practitioner | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Michael F Graham | Physician Assistant | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Cynthia Joan Maynes | Nurse Practitioner | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Bryan D Yates | Psychiatry | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Cynthia D Kusler | Nurse Practitioner | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Barbara A Bergeron | Nurse Practitioner | Centennial Medical Group East, LLC | 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471-6214 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael Brown | Radiation Oncology | Roseburg Oncology PC | 2880 Nw Stewart Pkwy, Suite 100, Roseburg, OR 97471-1201 |
| Sylvia Gosline | Radiation Oncology | Roseburg Oncology PC | 2880 Nw Stewart Pkwy, Suite 100, Roseburg, OR 97471-1201 |
| Randy L Moore | Radiation Oncology | Roseburg Oncology PC | 2880 Nw Stewart Pkwy, Suite 100, Roseburg, OR 97471-1201 |
| Scott R Moore | Physician Assistant | Roseburg Oncology PC | 2880 Nw Stewart Pkwy, Roseburg, OR 97471-1201 |
| Joshua Michael Weese | Hematology/oncology | Steelhead Specialty Group PC | 2880 Nw Stewart Pkwy, Suite 300, Roseburg, OR 97471-1205 |
| Stephen A Williams | Hematology/oncology | Steelhead Specialty Group PC | 2880 Nw Stewart Pkwy, Suite 300, Roseburg, OR 97471-1205 |
| Sara M Ray | Nurse Practitioner | Steelhead Specialty Group PC | 2880 Nw Stewart Pkwy, Suite 300, Roseburg, OR 97471-1205 |
| Kurt A Brickner | Internal Medicine | Galen Inpatient Physicians Inc | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 |
| Siobhan A Oreilly | Hospitalist | Galen Inpatient Physicians Inc | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 |
| Subhajit Mukherjee | Gastroenterology | Centennial Medical Group Inc | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 |
| Find all physicians in zip 97471 | |||
| City | ROSEBURG |
| Zip Code | 97471 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | ROSEBURG + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Michael Leslie Nichols.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.