Organization
CAPITAL REGION MEDICAL CENTER
Active
Other names
Capital Region Physicians - Southwest
Organization subpart
No
Provider details
NPI number
Authorized official
TOM LUEBBERING (VP OF FINANCE)
(573) 632-5100
Entity
Organization
Contact information
Practice address
1500 SOUTHWEST BLVD, STE D, JEFFERSON CITY, MO 65109
(573) 632-5780
(573) 632-5833
Mailing address
1500 SOUTHWEST BLVD, STE D, JEFFERSON CITY, MO 65109
(573) 632-5780
(573) 632-5833
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502474406
—
MO
01
—
CH7258
RR MEDICARE
MO
Enumeration date
02/09/2006
Last updated
08/23/2013
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