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General NPI Number Information
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NPI Number | 1679825244
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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 | 10/08/2012
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 1432 SOUTHWEST BLVD
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-2444
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Country | US
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Telephone | 573-632-5580
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Fax |
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Provider Business Mailing Address
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Address Line | 1432 SOUTHWEST BLVD
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-2444
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Country | US
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Telephone | 573-632-5580
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | TOM LUEBBERING
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Credential |
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Telephone | 573-632-5102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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