Capital Region Medical Center
Organization Active NPI Physical Medicine & Rehabilitation Physician · Jefferson City, MO
NPI 1336115385 · NPPES record last updated Aug 23, 2013
Key facts
- NPI
- 1336115385
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- Legal business name
- CAPITAL REGION MEDICAL CENTER
- Practice address
- 1432 Southwest Blvd
Jefferson City, MO 65109 - Phone
- (573) 632-5660
- Fax
- (573) 632-5859
- NPI assigned
- Feb 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Tom R Luebbering
- Title
- VP of Finance
- Phone
- (573) 632-5100
Corporate family (same tax ID) 46
National Provider Directory
- Tax ID family
- Capital Region Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | Yes |
Addresses
Primary practice location
1432 Southwest Blvd
Jefferson City, MO 65109
Mailing address
PO Box 1128
Jefferson City, MO 65102-1128
Phone (573) 632-5660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 505403709 | Medicaid | MO | |
| CD9211 | Other | MO | RR MEDICARE |
Other names
- Capital Region Physicians - Rehabilitation Specialists
Other providers in Jefferson City, MO
- Capital Region Medical Center
- Capital Region Medical Center
- Capital Region Medical Center
- Capital Region Medical Center
- Capital Region Medical Center
- Capital Region Medical Center
- Capital Region Medical Center
- Capital Region Medical Center
- Capital Region Medical Center
- Capital Region Medical Center
All providers in Jefferson City, MO · Physical Medicine & Rehabilitation Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.