Organization
CAPITAL REGION MEDICAL CENTER
Active
Other names
Capital Region Physicians - The Sloan Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TOM R LUEBBERING (VP OF FINANCE)
(573) 632-5100
Entity
Organization
Contact information
Practice address
1505 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109-2431
(573) 632-5544
Mailing address
3306 EMERALD LN, SUITE A, JEFFERSON CITY, MO 65109-6877
(573) 632-5544
(573) 635-0815
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
108684
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
249990557
—
MO
Enumeration date
11/18/2008
Last updated
04/10/2014
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