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 1235688805

Centennial Medical Group East, LLC is a Family Medicine Physician in Roseburg, Oregon. Licensed in Oregon. Registered with an NPI since 2016.

Licensed in
OR
In the registry since
2016
Specialties on file
2
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

1937 W Harvard Ave
Roseburg, OR 97471-2720
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

Rural Health Clinic/Center (primary) Taxonomy 261QR1300X · Licence 38-3896 (OR)
Family Medicine Physician Taxonomy 207Q00000X · Licence MD12182 (OR)

Record details

NPI number1235688805
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kim Tyree — Coo · (541) 229-3332
NPI enumeratedSeptember 23, 2016
Last updated in NPPESMay 1, 2020
Certification dateMay 1, 2020
Mailing address2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214

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