Healthcare Provider Details

I. General information

NPI: 1770042954
Provider Name (Legal Business Name): TOTAL ACCESS URGENT CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 S LINDBERGH BLVD
SAINT LOUIS MO
63125-4219
US

IV. Provider business mailing address

13861 MANCHESTER RD
BALLWIN MO
63011-4503
US

V. Phone/Fax

Practice location:
  • Phone: 314-380-8527
  • Fax: 314-380-8528
Mailing address:
  • Phone: 314-238-4660
  • Fax: 314-270-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BRUCKEL
Title or Position: PRESIDENT
Credential:
Phone: 314-961-2255