# CAPITAL REGION MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Capital Region Physicians - Rehabilitation Specialists
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336115385
- **Authorized official:** TOM R LUEBBERING (VP OF FINANCE)
- **Authorized official phone:** (573) 632-5100

## Contact information

- **Practice address:** 1432 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109
- **Practice address phone:** (573) 632-5660
- **Practice address fax:** (573) 632-5859
- **Mailing address:** PO BOX 1128, JEFFERSON CITY, MO 65102-1128
- **Mailing address phone:** (573) 632-5660
- **Mailing address fax:** (573) 632-5859

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/28/2006
- **Last updated:** 08/23/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 505403709 | — | MO |
| 01 | — | CD9211 | RR MEDICARE | MO |