MEDICARE: TOTAL ACCESS URGENT CARE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1922408426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL ACCESS URGENT CARE, PC

Provider Business Mailing Address
First Line	:	530 VANCE RD
Second Line	:
City	:	VALLEY PARK
State	:	MO
Zip	:	63088-1527
Country	:	US
Telephone Number	:	636-225-5445
Fax Number	:	636-225-5552

Provider Business Practice Location Address
First Line	:	3871 MEXICO RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3042
Country	:	US
Telephone Number	:	314-961-2255
Fax Number	:	636-477-6544

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW M BRUCKEL
Credential	:	M.D,
Telephone Number	:	314-961-2255

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/03/2014

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