Organization
CAPITAL REGION MEDICAL CENTER
Active
Organization
CAPITAL REGION MEDICAL CENTER
Active
Other names
Capital Region Physicians - Pediatric Associates
Organization subpart
No
Provider details
NPI number
Authorized official
TOM LUEBBERING (VP OF FINANCE)
(573) 632-5100
Entity
Organization
Contact information
Practice address
1014 MADISON ST, JEFFERSON CITY, MO 65102-3458
(573) 632-5525
(573) 632-5811
Mailing address
PO BOX 1107, JEFFERSON CITY, MO 65102-1107
(573) 632-5525
(573) 632-5811
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
41910
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507515500
—
MO
Enumeration date
04/08/2006
Last updated
08/23/2013
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