Organization
CAPITAL REGION MEDICAL CENTER
Active
Other names
Capital Region Physicians - Goldschmidt Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
TOM ALAN LUEBBERING (VP OF FINANCE)
(573) 632-5100
Entity
Organization
Contact information
Practice address
1432 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109
(573) 632-5482
(573) 632-5860
Mailing address
PO BOX 1128, JEFFERSON CITY, MO 65012-1128
(573) 632-5482
(573) 632-5860
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
207RX0202X
Medical Oncology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508925708
—
MO
01
—
C09211
RR MEDICARE
MO
Enumeration date
03/02/2006
Last updated
08/23/2013
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