Capital Region Medical Center
Organization Active NPI Family Medicine Physician · Jefferson City, MO
NPI 1649244690 · NPPES record last updated Aug 21, 2014
Key facts
- NPI
- 1649244690
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CAPITAL REGION MEDICAL CENTER
- Practice address
- 3308 W Edgewood Dr
Suite B
Jefferson City, MO 65109-6891 - Phone
- (573) 893-7848
- Fax
- (573) 893-1984
- NPI assigned
- Feb 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Tom 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 |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
3308 W Edgewood Dr
Suite B
Jefferson City, MO 65109-6891
Mailing address
3308 W Edgewood Dr
Suite B
Jefferson City, MO 65109-6891
Phone (573) 893-7848
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 507613909 | Medicaid | MO | |
| PA2614 | Other | MO | RR MEDICARE |
Other names
- Capital Region Physicians - Edgewood Urgent Care
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 · Family Medicine 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 21, 2014. 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.