| Organization Name: | CAPITAL REGION RESIDENT CLINIC |
| NPI Number: | 1649514050 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TOM LUEBBERING (VP OF FINANCE) |
| Mailing Address: | 220 Madison St. Jefferson City |
| State: | MO US |
| Postal Code: | 65102 |
| Phone Number: | 5736324900 |
| Fax Number: | 5736446650 |
| NPI Enumeration Date: | 11/26/2012 |
| NPI Last Update Date: | 06/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |