Organization
CAPITAL REGION MEDICAL CENTER
Active
Other names
Radiance Medical Spa and Vein Care
Organization subpart
No
Provider details
NPI number
Authorized official
TOM LUEBBERING (VICE PRESIDENT OF FINANCE)
(573) 632-5102
Entity
Organization
Contact information
Practice address
1432 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109-2444
(573) 632-5580
Mailing address
1432 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109-2444
(573) 632-5580
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
—
Other
Enumeration date
10/08/2012
Last updated
12/19/2013
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