Healthcare Provider Details

I. General information

NPI: 1922408426
Provider Name (Legal Business Name): TOTAL ACCESS URGENT CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 MEXICO RD
SAINT CHARLES MO
63303-3042
US

IV. Provider business mailing address

530 VANCE RD
VALLEY PARK MO
63088-1527
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-2255
  • Fax: 636-477-6544
Mailing address:
  • Phone: 636-225-5445
  • Fax: 636-225-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW M BRUCKEL
Title or Position: PRESIDENT
Credential: M.D,
Phone: 314-961-2255