# CAPITAL REGION MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Capital Region Physicians - Madison Street OB/GYN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083912265
- **Authorized official:** TOM LUEBBERING (VP OF FINANCE)
- **Authorized official phone:** (573) 632-5100

## Contact information

- **Practice address:** 1014 MADISON ST, SUITE B, JEFFERSON CITY, MO 65101-3458
- **Practice address phone:** (573) 634-3496
- **Practice address fax:** (573) 635-5260
- **Mailing address:** 1014 MADISON ST, SUITE B, JEFFERSON CITY, MO 65101-3458
- **Mailing address phone:** (573) 634-3496
- **Mailing address fax:** (573) 635-5260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 419-15 | MO | Yes |

## Other

- **Enumeration date:** 03/11/2011
- **Last updated:** 08/23/2013