# CAPITAL REGION MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Capital Region Physicians - Edgewood Urgent Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649244690
- **Authorized official:** TOM LUEBBERING (VP OF FINANCE)
- **Authorized official phone:** (573) 632-5100

## Contact information

- **Practice address:** 3308 W EDGEWOOD DR, SUITE B, JEFFERSON CITY, MO 65109-6891
- **Practice address phone:** (573) 893-7848
- **Practice address fax:** (573) 893-1984
- **Mailing address:** 3308 W EDGEWOOD DR, SUITE B, JEFFERSON CITY, MO 65109-6891
- **Mailing address phone:** (573) 893-7848
- **Mailing address fax:** (573) 893-1984

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/15/2006
- **Last updated:** 08/21/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 507613909 | — | MO |
| 01 | — | PA2614 | RR MEDICARE | MO |