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CAPITAL REGION MEDICAL CENTER NPI 1649244690


NPI Information

NPI: 1649244690
Provider Name: CAPITAL REGION MEDICAL CENTER

Doing Business As: CAPITAL REGION PHYSICIANS - EDGEWOOD URGENT CARE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 26D0446113

Address:
3308 W EDGEWOOD DR
SUITE B
JEFFERSON CITY, MO
ZIP 65109
Phone: (573) 893-7848
Get Directions

CAPITAL REGION MEDICAL CENTER is a family medicine in Jefferson City, MO. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CAPITAL REGION MEDICAL CENTER NPI is 1649244690. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Capital Region Physicians - Edgewood Urgent Care.

The provider's business location address is:

3308 W EDGEWOOD DR
SUITE B
JEFFERSON CITY, MO
ZIP 65109-891
Phone: (573) 893-7848
Fax: (573) 893-1984

The provider's authorized official is Tom Luebbering .
The authorized official title is Vp Of Finance and has the following contact phone number (573) 632-5100.

The CLIA number assigned to this NPI record is 26D0446113 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/15/2006 and was last updated on 8/21/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363LF0000XNurse PractitionerFamilyNo
2207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000012084MEDICARE ID-TYPE UNSPECIFIEDMISSOURI
2507613909MEDICAIDMISSOURI
3PA2614OTHERMISSOURIRR MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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