# CAPITAL REGION MEDICAL CENTER

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

## Provider details

- **NPI number:** 1730151143
- **Authorized official:** TOM LUEBBERING (VP OF FINANCE)
- **Authorized official phone:** (573) 632-5100

## Contact information

- **Practice address:** 704 BUCHANAN HWY SW, CALIFORNIA, MO 65018
- **Practice address phone:** (573) 796-3111
- **Practice address fax:** (573) 796-3042
- **Mailing address:** 704 BUCHANAN HWY SW, CALIFORNIA, MO 65018
- **Mailing address phone:** (573) 796-3111
- **Mailing address fax:** (573) 796-3042

## Taxonomy

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

## Other

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

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 507984300 | — | MO |
| 01 | — | CK5622 | RR MEDICARE | MO |