# CAPITAL REGION MEDICAL CENTER

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

## Provider details

- **NPI number:** 1679701296
- **Authorized official:** TOM LUEBBERING (VP OF FINANCE)
- **Authorized official phone:** (573) 632-5100

## Contact information

- **Practice address:** 3308 W EDGEWOOD, SUITE B, JEFFERSON CITY, MO 65109
- **Practice address phone:** (573) 644-6999
- **Practice address fax:** (573) 644-7880
- **Mailing address:** PO BOX 1128, JEFFERSON CITY, MO 65102-1128
- **Mailing address phone:** (573) 644-6999
- **Mailing address fax:** (573) 644-7880

## Taxonomy

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

## Other

- **Enumeration date:** 06/23/2009
- **Last updated:** 08/21/2014