Provider Demographics
NPI:1356823397
Name:TOTAL ACCESS URGENT CARE P.C.
Entity Type:Organization
Organization Name:TOTAL ACCESS URGENT CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-961-2255
Mailing Address - Street 1:13861 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4503
Mailing Address - Country:US
Mailing Address - Phone:314-696-2341
Mailing Address - Fax:
Practice Address - Street 1:2060 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2903
Practice Address - Country:US
Practice Address - Phone:314-696-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL ACCESS URGENT CARE P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
000015584OtherPTAN