Organization
CAPITAL REGION MEDICAL CENTER
Active
Other names
Capital Region Physicians - Radiology
Organization subpart
No
Provider details
NPI number
Authorized official
TOM LUEBBERING (VP OF FINANCE)
(573) 632-5100
Entity
Organization
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65102-5227
(573) 632-5000
(573) 632-5876
Mailing address
PO BOX 1128, JEFFERSON CITY, MO 65102-1128
(573) 632-5000
(573) 632-5876
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507398006
—
MO
Enumeration date
05/19/2008
Last updated
08/23/2013
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