Provider Demographics
NPI:1952853889
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 1:9556 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1313
Mailing Address - Country:US
Mailing Address - Phone:314-961-2255
Mailing Address - Fax:314-270-3694
Practice Address - Street 1:4201 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8230
Practice Address - Country:US
Practice Address - Phone:314-961-2255
Practice Address - Fax:314-270-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005029371261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015584Medicare UPIN