Basic Information
| Provider Information | |||||||||
| NPI: | 1922408426 | ||||||||
| 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: | 6362255445 | ||||||||
| FaxNumber: | 6362255552 | ||||||||
| Practice Location | |||||||||
| Address1: | 3871 MEXICO RD | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633033042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149612255 | ||||||||
| FaxNumber: | 6364776544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2014 | ||||||||
| LastUpdateDate: | 09/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | BRUCKEL | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3149612255 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D, | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.