Healthcare Provider Details

I. General information

NPI: 1134188741
Provider Name (Legal Business Name): CAPITAL REGION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 KUHNE ROAD
OWENSVILLE MO
65066
US

IV. Provider business mailing address

3536 KUHNE ROAD
OWENSVILLE MO
65066
US

V. Phone/Fax

Practice location:
  • Phone: 573-437-4168
  • Fax: 573-437-4242
Mailing address:
  • Phone: 573-437-4168
  • Fax: 573-437-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number4199
License Number StateMO

VIII. Authorized Official

Name: TOM LUEBBERING
Title or Position: VP OF FINANCE
Credential:
Phone: 573-632-5100