Basic Information
| Provider Information | |||||||||
| NPI: | 1326482746 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL ACCESS URGENT CARE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 VANCE RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY PARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630881527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362259447 | ||||||||
| FaxNumber: | 6362255552 | ||||||||
| Practice Location | |||||||||
| Address1: | 13861 MANCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630114503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149612255 | ||||||||
| FaxNumber: | 6362209334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2013 | ||||||||
| LastUpdateDate: | 04/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRUCKEL | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3149612255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.