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CENTENNIAL MEDICAL GROUP EAST, LLC
NPI 1134243249
Obstetrics & Gynecology in Roseburg, OR

Active since March 16, 2007CLIA Certified · 2 labs
1937 W HARVARD AVE, ROSEBURG, OR 97471(541) 677-7200(541) 229-3309 Get Directions Write a Review

NPPES record last updated: May 1, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Centennial Medical Group East, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTENNIAL MEDICAL GROUP EAST, LLC (NPI 1134243249) is a healthcare organization registered as an obstetrics & gynecology in Roseburg, Oregon and active in the NPI registry since March 2007. The organization holds 2 active CLIA laboratory certificates and lists Kimberly Tyree, Coo, as its authorized official.

NPPES Registry Identity

NPI1134243249
Entity TypeOrganization
Primary Taxonomy207V00000X
Legal Business NameCENTENNIAL MEDICAL GROUP EAST, LLC
Location Address1937 W HARVARD AVERoseburg, OR 97471-2720
Mailing Address2570 Nw Edenbower BlvdRoseburg, OR 97471-6214 · (541) 677-7200 · Fax (541) 677-7462
Phone(541) 677-7200
Fax(541) 229-3309
Organization SubpartNo
Authorized OfficialKimberly TyreeCoo · (541) 229-3332
Enumeration DateMarch 16, 2007
Last NPPES UpdateMay 1, 2020
NPPES CertifiedMay 1, 2020
✔ NPI 1134243249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
1937 W HARVARD AVE, Roseburg, OR 97471
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 38D0627341

Centennial Medical Group East · Roseburg, OR
Active · expires Dec 31, 2027
CLIA Number38D0627341
Laboratory TypePhysician Office
Certificate Effective DateJanuary 1, 2026
Certificate Expiration DateDecember 31, 2027
Laboratory DirectorTimothy J. Powell MD
Laboratory Phone(541) 677-7200
Laboratory LocationCentennial Medical Group East2570 NW Edenbower Blvd #100, Roseburg, OR 97471
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Waiver 38D2280627

Centennial Medical Group East Dba Evergreen Family Medicine North · Sutherlin, OR
Active · expires Apr 23, 2027
CLIA Number38D2280627
Laboratory TypeRural Health Clinic
Certificate Effective DateApril 24, 2025
Certificate Expiration DateApril 23, 2027
Laboratory DirectorTimothy J. Powell
Laboratory Phone(541) 229-3332
Laboratory LocationCentennial Medical Group East Dba Evergreen Family Medicine North249 Dakota Street, Sutherlin, OR 97479
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VISHAL KOTTAPALLI DO
Family Medicine
1937 W HARVARD AVE
ROSEBURG, OR 97471
Douglas County (541) 677-7200
MATTHEW T STARK PA-C.
Physician Assistant (Medical)
1937 W HARVARD AVE
ROSEBURG, OR 97471
Douglas County (541) 677-7200
CENTENNIAL MEDICAL GROUP EAST, LLC
Clinic/Center (Rural Health)
1937 W HARVARD AVE
ROSEBURG, OR 97471
Douglas County (541) 677-7200
BRITAIN LARSON PARRISH MD
Family Medicine
1937 W HARVARD AVE
ROSEBURG, OR 97471
Douglas County (541) 677-7200
DAVID MYHILL CHW
Community Health Worker
1937 W HARVARD AVE
ROSEBURG, OR 97471
Douglas County (541) 677-7200
ANCA M DAUER DO
Family Medicine
1937 W HARVARD AVE
ROSEBURG, OR 97471
Douglas County (541) 677-7200
EMMANUEL OKENYE
Internal Medicine
1937 W HARVARD AVE
ROSEBURG, OR 97471
Douglas County (541) 677-7200
PAMELA H ELLENBURG DO
Family Medicine
1937 W HARVARD AVE
ROSEBURG, OR 97471
Douglas County (541) 677-7200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Centennial Medical Group East, LLC's NPI number?

The NPI number for Centennial Medical Group East, LLC is 1134243249. It was assigned to this organization in the NPPES registry on March 16, 2007.

Where is Centennial Medical Group East, LLC located?

Centennial Medical Group East, LLC is located at 1937 W Harvard Ave, Roseburg, OR 97471. The listed phone number is (541) 677-7200.

What is Centennial Medical Group East, LLC's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Does Centennial Medical Group East, LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Centennial Medical Group East, LLC was last updated on May 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.