OrganizationActive
Centennial Medical Group East, LLC
NPI 1699103598 · Rural Health Clinic/Center · Myrtle Creek, OR
Provider details
- NPI number
- 1699103598
- Entity type
- Organization
- Primary specialty
- Rural Health Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- Centennial Medical Group Dba Evergreen Family Medicine South
- Organization subpart
- Yes
- Authorized official
- Kim Tyree, Coo(541) 229-3332
- License
- 71216890 (OR)
Specialties & taxonomies
Ambulatory Health Care Facilities
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
Practice location
145 Ne Broadway St
Myrtle Creek, OR 97457-9039
Phone: (541) 863-3146
Fax: (541) 863-3226
Approximate (ZIP-level) locationGet directions
Mailing address
2801 Nw Mercy Dr
Roseburg, OR 97471-2348
Other names (DBA / former)
- Doing business as
- Evergreen Family Medicine South
Registry dates
- Enumerated
- 2013-10-31
- Last updated
- 2016-11-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.