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

Centennial Medical Group East, LLC

Organization Family Medicine Physician · NPI 1164124111

Centennial Medical Group East, LLC is a Family Medicine Physician in Sutherlin, Oregon. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

249 Dakota St
Sutherlin, OR 97479-9908
Phone: (541) 677-7200
Fax: (541) 229-3309
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1164124111
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationCentennial Medical Group East, LLC
Authorized official Kimberly Tyree — Chief Operating Officer · (541) 229-3332
Other names Evergreen Family Medicine North
NPI enumeratedMarch 21, 2023
Last updated in NPPESMarch 21, 2023
Certification dateMarch 21, 2023
Mailing address2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214

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