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Capital Region Medical Center

Organization Active NPI Family Medicine Physician · Jefferson City, MO

NPI 1124091285 · NPPES record last updated Aug 23, 2013

Key facts

NPI
1124091285
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
CAPITAL REGION MEDICAL CENTER
Practice address
1500 Southwest Blvd
Ste D
Jefferson City, MO 65109
Phone
(573) 632-5780
Fax
(573) 632-5833
NPI assigned
Feb 9, 2006
Organization subpart
No

Authorized official

Name
Tom Luebbering
Title
VP of Finance
Phone
(573) 632-5100

Corporate family (same tax ID) 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

National Provider Directory

Tax ID family
Capital Region Medical Center (47 organizations share this tax ID)

Locations

1500 Southwest Blvd
Ste D
Jefferson Cty, MO 65109
Phone (573) 632-5780

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X

Addresses

Primary practice location

1500 Southwest Blvd
Ste D
Jefferson City, MO 65109

Mailing address

1500 Southwest Blvd
Ste D
Jefferson City, MO 65109
Phone (573) 632-5780

Other identifiers

IdentifierTypeStateIssuer
502474406MedicaidMO
CH7258OtherMORR MEDICARE

Other names

  • Capital Region Physicians - Southwest Doing business as

Other providers in Jefferson City, MO

All providers in Jefferson City, MO · Family Medicine Physician in Missouri

Sources for this page

Verify at the official NPI Registry.