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General NPI Number Information
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NPI Number | 1447405568
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Entity Type | Organization
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Legal Business Name | CAPITAL REGION MEDICAL CENTER
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 1505 SOUTHWEST BLVD
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-2431
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Country | US
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Telephone | 573-632-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 3306 EMERALD LN SUITE A
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-6877
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Country | US
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Telephone | 573-632-5544
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Fax | 573-635-0815
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | TOM R LUEBBERING
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Credential |
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Telephone | 573-632-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 108684
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License Number State | MO
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