Provider Demographics
NPI:1326482746
Name:TOTAL ACCESS URGENT CARE, PC
Entity Type:Organization
Organization Name:TOTAL ACCESS URGENT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRUCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-961-2255
Mailing Address - Street 1:530 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1527
Mailing Address - Country:US
Mailing Address - Phone:636-225-9447
Mailing Address - Fax:636-225-5552
Practice Address - Street 1:13861 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4503
Practice Address - Country:US
Practice Address - Phone:314-961-2255
Practice Address - Fax:636-220-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015584Medicare PIN