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Organization
CAPITAL REGION MEDICAL CENTER
Active
Organization
CAPITAL REGION MEDICAL CENTER
Active
Other names
Capital Region Physicians - Edgewood Urgent Care
Organization subpart
No
Provider details
NPI number
Authorized official
TOM LUEBBERING (VP OF FINANCE)
(573) 632-5100
Entity
Organization
Contact information
Practice address
3308 W EDGEWOOD DR, SUITE B, JEFFERSON CITY, MO 65109-6891
(573) 893-7848
(573) 893-1984
Mailing address
3308 W EDGEWOOD DR, SUITE B, JEFFERSON CITY, MO 65109-6891
(573) 893-7848
(573) 893-1984
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507613909
—
MO
01
—
PA2614
RR MEDICARE
MO
Enumeration date
02/15/2006
Last updated
08/21/2014
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