NPIMap

Organization Active NPI

Centennial Medical Group West, LLC

  • Ophthalmology Physician
  • Roseburg, OR
National Provider Identifier
1245547744
Registry record updated Mar 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
CENTENNIAL MEDICAL GROUP WEST, LLC
Practice address
2801 NW Mercy Dr.
Ste. 340
Roseburg, OR 97471
Phone
(541) 677-4319
Fax
(541) 677-2294
NPI assigned
Sep 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2017

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

Authorized official

Name
Douglas Klebe
Title
Officer
Phone
(541) 677-3650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

2801 NW Mercy Dr.
Ste. 340
Roseburg, OR 97471

Mailing address

2801 NW Mercy Dr.
Ste. 340
Roseburg, OR 97471
Phone (541) 677-4319

Other identifiers 1

IdentifierTypeStateIssuer
500626861MedicaidOR

National Provider Directory

National Provider Directory

Locations

340 NW Medical Loop
Ste 120
Roseburg, OR 97471
Phone (541) 672-8288

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1283472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488844800000",
    "number": "1245547744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 NW MERCY DR.",
            "address_2": "STE. 340",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "97471",
            "telephone_number": "541-677-4319",
            "fax_number": "541-677-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 NW MERCY DR.",
            "address_2": "STE. 340",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "97471",
            "telephone_number": "541-677-4319",
            "fax_number": "541-677-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL MEDICAL GROUP WEST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-03",
        "last_updated": "2017-03-07",
        "status": "A",
        "authorized_official_last_name": "KLEBE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "541-677-3650"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500626861",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.