# CAPITAL REGION MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Capital Region Physicians - Holts Summit
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710959598
- **Authorized official:** TOM LUEBBERING (VP OF FINANCE)
- **Authorized official phone:** (573) 632-5100

## Contact information

- **Practice address:** 180 NORTHSTAR ST, HOLTS SUMMIT, MO 65043-1123
- **Practice address phone:** (573) 896-5115
- **Practice address fax:** (573) 896-4272
- **Mailing address:** 180 NORTHSTAR ST, HOLTS SUMMIT, MO 65043-1123
- **Mailing address phone:** (573) 896-5115
- **Mailing address fax:** (573) 896-4272

## Taxonomy

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

## Other

- **Enumeration date:** 02/06/2006
- **Last updated:** 08/23/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 501607808 | — | MO |