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
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700043791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL REGION MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1128
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65102-1128
Country	:	US
Telephone Number	:	573-632-5000
Fax Number	:	573-632-5876

Provider Business Practice Location Address
First Line	:	1125 MADISON ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65102-5227
Country	:	US
Telephone Number	:	573-632-5000
Fax Number	:	573-632-5876

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	TOM LUEBBERING
Credential	:
Telephone Number	:	573-632-5100

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	08/23/2013

Similar Medicare Providers

1629031018 — CAPITAL REGION MEDICAL CENTER
Practice Location Address:

1014 MADISON ST
JEFFERSON CITY, MO
65102-3458

Practice Phone: 573-632-5525
Practice Fax: 573-632-5811

1003872714 — ELBERT STINSON TILLERSON MD
Practice Location Address:

1125 MADISON ST.
JEFFERSON CITY, MO
65102-1128

Practice Phone: 573-635-7651
Practice Fax: 573-659-4515

1639287915 — HEATHER MCBEE JOHNS LCSW
Practice Location Address:

1432 SOUTHWEST BLVD
JEFFERSON CITY, MO
65102-1128

Practice Phone: 573-632-5560
Practice Fax: 573-632-5875

1265577852 — MRS. BETHANY NAUGHTON OTR-L
Practice Location Address:

1432 SOUTHWEST BLVD , CAPTIAL REGION HOME HEALTH
JEFFERSON CITY, MO
65102-1128

Practice Phone: 573-632-5752
Practice Fax: 573-632-5868

1013120583 — MRS. CHRISTIE L STOCKTON P.T.
Practice Location Address:

1125 MADISON
JEFFERSON CITY, MO
65102-1128

Practice Phone: 573-632-5621
Practice Fax:

1780867085 — ANNIE MARIE NELSON RD
Practice Location Address:

1610 SOUTHRIDGE DR
JEFFERSON CITY, MO
65102-9743

Practice Phone: 573-751-6303
Practice Fax:

Directions to “CAPITAL REGION MEDICAL CENTER ” Practice Location

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