# CAPITAL REGION MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Capital Region Physicians - Family Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104001676
- **Authorized official:** TOM LUEBBERING (VP OF FINANCE)
- **Authorized official phone:** (573) 632-5100

## Contact information

- **Practice address:** 420 E HIGH ST, JEFFERSON CITY, MO 65101-3215
- **Practice address phone:** (573) 635-0916
- **Practice address fax:** (573) 635-8812
- **Mailing address:** 420 E HIGH ST, JEFFERSON CITY, MO 65101-3215
- **Mailing address phone:** (573) 635-0916
- **Mailing address fax:** (573) 635-8812

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/03/2008
- **Last updated:** 08/23/2013