Provider Demographics
NPI:1346791837
Name:TOTAL ACCESS URGENT CARE, PC
Entity type:Organization
Organization Name:TOTAL ACCESS URGENT CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:DINKEL
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:636-556-0114
Mailing Address - Fax:314-270-3694
Practice Address - Street 1:1090 N HIGHWAY 67 ST
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4720
Practice Address - Country:US
Practice Address - Phone:314-961-2255
Practice Address - Fax:314-270-3694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL ACCESS URGENT CARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2024-07-28
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