# CAPITAL REGION MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Capital Region Physicians - Miller Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255762852
- **Authorized official:** TOM LUEBBERING (VICE PRESIDENT OF FINANCE)
- **Authorized official phone:** (573) 632-5100

## Contact information

- **Practice address:** 1705 CHRISTY DR, SUITE 201, JEFFERSON CITY, MO 65101-5195
- **Practice address phone:** (573) 635-0621
- **Practice address fax:** (573) 635-3534
- **Mailing address:** 1705 CHRISTY DR, SUITE 201, JEFFERSON CITY, MO 65101-5195
- **Mailing address phone:** (573) 635-0621
- **Mailing address fax:** (573) 635-3534

## Taxonomy

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

## Other

- **Enumeration date:** 12/06/2013
- **Last updated:** 12/06/2013