Capital Region Medical Center
Organization Active NPI Family Medicine Physician · California, MO
NPI 1730151143 · NPPES record last updated Aug 23, 2013
Key facts
- NPI
- 1730151143
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CAPITAL REGION MEDICAL CENTER
- Practice address
- 704 Buchanan Hwy SW
California, MO 65018 - Phone
- (573) 796-3111
- Fax
- (573) 796-3042
- NPI assigned
- Feb 2, 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
Locations
704 W Buchanan St
California, MO 65018
Phone (573) 796-3111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
704 Buchanan Hwy SW
California, MO 65018
Mailing address
704 Buchanan Hwy SW
California, MO 65018
Phone (573) 796-3111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CK5622 | Other | MO | RR MEDICARE |
| 507984300 | Medicaid | MO |
Other names
- Capital Region Physicians - California
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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.