Healthcare Provider Details
I. General information
NPI: 1831601897
Provider Name (Legal Business Name): TOTAL ACCESS URGENT CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/31/2017
Last Update Date: 07/28/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
507 S MAIN ST
O FALLON MO
63366-2534
US
IV. Provider business mailing address
13861 MANCHESTER RD
BALLWIN MO
63011-4503
US
V. Phone/Fax
- Phone: 636-409-1092
- Fax: 314-409-1132
- Phone: 636-556-0114
- Fax: 314-270-3694
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QU0200X |
| Taxonomy | Urgent Care Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
TROY
ADAM
DINKEL
Title or Position: OWNER
Credential: MD
Phone: 314-961-2255