| Capital Region Physicians - Pediatric Associates | |
|
1014 Madison St Jefferson City MO 65102-3458 | |
| (573) 632-5525 | |
| (573) 632-5811 |
| Full Name | Capital Region Physicians - Pediatric Associates |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1014 Madison St, Jefferson City, Missouri |
| Authorized Official Name and Position | Tom Luebbering (VP OF FINANCE) |
| Authorized Official Contact | 5736325100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital Region Physicians - Pediatric Associates Po Box 1107 Jefferson City MO 65102-1107 Ph: (573) 632-5525 | Capital Region Physicians - Pediatric Associates 1014 Madison St Jefferson City MO 65102-3458 Ph: (573) 632-5525 |
| NPI Number | 1629031018 |
|---|---|
| Provider Enumeration Date | 04/08/2006 |
| Last Update Date | 08/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629031018 | NPI | - | NPPES |
| 507515500 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 41910 (Missouri) | Primary |
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