1245714849 NPI number — TOTAL ACCESS URGENT CARE, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245714849 NPI number — TOTAL ACCESS URGENT CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL ACCESS URGENT CARE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245714849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13861 MANCHESTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63011-4503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-556-0114
Provider Business Mailing Address Fax Number:
314-270-3694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 S BIG BEND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-449-8677
Provider Business Practice Location Address Fax Number:
314-449-8678
Provider Enumeration Date:
09/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DINKEL
Authorized Official First Name:
TROY
Authorized Official Middle Name:
ADAM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-556-0114

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000015584 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".




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