| Centennial Medical Group East, Llc | |
|
249 Dakota St Sutherlin OR 97479-9908 | |
| (541) 677-7200 | |
| (541) 229-3309 |
| Full Name | Centennial Medical Group East, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 249 Dakota St, Sutherlin, Oregon |
| Authorized Official Name and Position | Kimberly Tyree (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 5412293332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centennial Medical Group East, Llc 2570 Nw Edenbower Blvd Ste 100 Roseburg OR 97471-6214 Ph: (541) 677-7200 | Centennial Medical Group East, Llc 249 Dakota St Sutherlin OR 97479-9908 Ph: (541) 677-7200 |
| NPI Number | 1164124111 |
|---|---|
| Provider Enumeration Date | 03/21/2023 |
| Last Update Date | 03/21/2023 |
| Medicare PECOS PAC ID | 9234397878 |
|---|---|
| Medicare Enrollment ID | O20230419000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164124111 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Sutherlin Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 781 W Central Ave, Sutherlin, OR 97479 Phone: 541-459-0303 Fax: 541-459-1657 | |
Umpqua Community Health Center, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 775 Taylor St., Sutherlin, OR 97479 Phone: 541-672-9596 |