Provider Demographics
NPI:1770042954
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:
Authorized Official - Last Name:BRUCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
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:314-238-4660
Mailing Address - Fax:314-270-3694
Practice Address - Street 1:6940 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4219
Practice Address - Country:US
Practice Address - Phone:314-380-8527
Practice Address - Fax:314-380-8528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL ACCESS URGENT CARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
000015584OtherPTAN