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CENTENNIAL MEDICAL GROUP INC.

Physicians Internal Medicine Cardiovascular Disease

Provider NPI: 1518103274

Organization Information:
Organization Name:  CENTENNIAL MEDICAL GROUP INC.
Organization is Subpart
Authorized Official:  DONNA RAYLENE VAN DIS  CREDENTIALING COORDINATOR  541-677-4319

Practice Location:
201 NW MEDICAL LOOP STE 190  ROSEBURG, OR 97471-8835 US
Tel: 541-644-4319  Fax: 541-677-2294

Business Mailing Address:
201 NW MEDICAL LOOP STE 190  ROSEBURG, OR 97471-8835 US
Tel: 541-644-4319  Fax: 541-677-2294

NPI Information:
NPI: 1518103274
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N207RC0000XPhysicians
Internal Medicine
Cardiovascular Disease
N207RG0100XPhysicians
Internal Medicine
N207RP1001XPhysicians
Internal Medicine
N207RS0012XPhysicians
Internal Medicine
N207ZP0105XPhysicians
Pathology
N208800000XPhysicians
Urology
N208M00000XPhysicians
Hospitalist
Y208600000XPhysicians
Surgery

Other Provider Identifiers:

IssuerNumberStateType
500601997OR05



American Medical Association 2012 taxonomy code information

Code: 208600000X

Type:

Classification:



Definition:



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