Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Centennial Medical Group East, LLC

Organization Emergency Medicine Physician · NPI 1134436637

Centennial Medical Group East, LLC is an Emergency Medicine Physician in Roseburg, Oregon. Licensed in Oregon. Registered with an NPI since 2010.

Licensed in
OR
In the registry since
2010
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2570 NW Edenbower Blvd
Roseburg, OR 97471-6214
Phone: (541) 677-2494
Fax: (541) 677-2294
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 71216890 (OR)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 71216890 (OR)
Physician Assistant Taxonomy 363A00000X · Licence 71216890 (OR)

Record details

NPI number1134436637
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationCentennial Medical Group, Inc
Authorized official Kimberly Tyree — Coo · (541) 229-3332
NPI enumeratedSeptember 3, 2010
Last updated in NPPESJuly 1, 2025
Certification dateJuly 1, 2025
Mailing address2570 Nw Edenbower Blvd, Roseburg, OR 97471-6214

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