| Centennial Medical Group East, Llc | |
|
145 Ne Broadway St Myrtle Creek OR 97457-9039 | |
| (541) 863-3146 | |
| (541) 863-3226 |
| Full Name | Centennial Medical Group East, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 145 Ne Broadway St, Myrtle Creek, Oregon |
| Authorized Official Name and Position | Kim Tyree (COO) |
| Authorized Official Contact | 5412293332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centennial Medical Group East, Llc 2801 Nw Mercy Dr Suite 340 Roseburg OR 97471-2348 Ph: (541) 677-2494 | Centennial Medical Group East, Llc 145 Ne Broadway St Myrtle Creek OR 97457-9039 Ph: (541) 863-3146 |
| NPI Number | 1699103598 |
|---|---|
| Provider Enumeration Date | 10/31/2013 |
| Last Update Date | 11/22/2016 |
| Medicare PECOS PAC ID | 9234397878 |
|---|---|
| Medicare Enrollment ID | O20140407001744 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699103598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 71216890 (Oregon) | Secondary |
| 207Q00000X | Family Medicine | (Oregon) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (Oregon) | Primary |
Mark M Herscher Do Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 145 Ne Broadway, Myrtle Creek, OR 97457 Phone: 541-863-3146 Fax: 541-863-3226 |