Provider Demographics
NPI:1427631548
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:CEO
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:314-238-4660
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 1:6803 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2311
Practice Address - Country:US
Practice Address - Phone:314-238-4660
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:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962684886OtherNPI MAIN