Centennial Medical Group West, LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

CENTENNIAL MEDICAL GROUP WEST, LLC

Practice address

2700 NW Stewart Pkwy
Roseburg, OR 97471-1281

Phone

(541) 677-2494

Fax

(541) 677-2294

NPI assigned

Mar 15, 2011

Organization subpart

Yes

Parent organization

CENTENNIAL MEDICAL GROUP, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rahul Agarwal

Title

President

Phone

(541) 677-2494

Specialties & licenses 1

Addresses

Other names 1

• Centennial Surgical Assistants Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Centennial Medical Group West LLC2 organizations share this tax ID, including this one

Part of

Centennial Medical Group

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Centennial Medical Group West, LLC

  • Gastroenterology Physician
  • Roseburg, OR
  • NPI 1891003497
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300147200000",
    "number": "1063710192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 NW MERCY DR STE 340",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712348",
            "telephone_number": "541-677-2494",
            "fax_number": "541-677-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 NW STEWART PKWY",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974711281",
            "telephone_number": "541-677-2494",
            "fax_number": "541-677-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL MEDICAL GROUP WEST, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTENNIAL MEDICAL GROUP, INC.",
        "enumeration_date": "2011-03-15",
        "last_updated": "2011-03-15",
        "status": "A",
        "authorized_official_last_name": "AGARWAL",
        "authorized_official_first_name": "RAHUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-677-2494"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centennial Surgical Assistants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Centennial Medical Group East, LLC
• Centennial Medical Group Inc.
• Centennial Medical Group Inc.
• Centennial Medical Group North, LLC
• Centennial Medical Group North, LLC
• Centennial Medical Group West, LLC
• Centennial Medical Group West, LLC
• Centennial Medical Group, Inc
• Cep America - Anesthesia PC
• Cep America - Psychiatry PC

• Surgical Physician Assistant in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Surgical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.