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NPI Code Detail

MEDICARE: CAPITAL REGION MEDICAL CENTER

MEDICARE: CAPITAL REGION MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician419-15MO

General Provider Information

NPI Number : 1083912265
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAPITAL REGION MEDICAL CENTER
Provider Business Mailing Address
First Line : 1014 MADISON ST
Second Line : SUITE B
City : JEFFERSON CITY
State : MO
Zip : 65101-3458
Country : US
Telephone Number : 573-634-3496
Fax Number : 573-635-5260
Provider Business Practice Location Address
First Line : 1014 MADISON ST
Second Line : SUITE B
City : JEFFERSON CITY
State : MO
Zip : 65101-3458
Country : US
Telephone Number : 573-634-3496
Fax Number : 573-635-5260
Authorized Official
Title or Position : VP OF FINANCE
Name : TOM LUEBBERING
Credential :
Telephone Number : 573-632-5100
Provider Enumeration Date : 03/11/2011
Last Update Date : 08/23/2013

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Directions to “CAPITAL REGION MEDICAL CENTER ” Practice Location

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