Centennial Medical Group Inc.

NPI #1518103274 in Roseburg, Oregon

Provider Information

NPI Number: 1518103274
Entity Type: Organization
Organization Name: Centennial Medical Group Inc.
Subpart: Yes (part of a larger organization)
Parent Organization: CENTENNIAL MEDICAL GROUP INC.
Primary Specialty: Surgery
Enumeration Date: Dec 31, 2008
Last Updated: Nov 25, 2019

Practice Location

Address: 201 NW MEDICAL LOOP STE 190
City: Roseburg
State: Oregon
ZIP Code: 97471-8835
Phone: (541) 644-4319

Authorized Official

Name: DONNA RAYLENE VAN DIS
Title: CREDENTIALING COORDINATOR
Phone: (541) 677-4319

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine - Cardiovascular Disease — Cardiovascular Disease	207RC0000X
Internal Medicine - Gastroenterology — Gastroenterology	207RG0100X
Internal Medicine - Pulmonary Disease — Pulmonary Disease	207RP1001X
Internal Medicine - Sleep Medicine — Sleep Medicine	207RS0012X
Pathology - Clinical Pathology/Laboratory Medicine — Clinical Pathology/Laboratory Medicine	207ZP0105X
Urology	208800000X
Hospitalist	208M00000X
Surgery	208600000X	Primary

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