# TOTAL CARE PAIN CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518589431
- **Authorized official:** IVAN FOM MD (OWNER)
- **Authorized official phone:** (563) 564-1283

## Contact information

- **Practice address:** 9026 CULEBRA RD STE 101, SAN ANTONIO, TX 78251-2882
- **Practice address phone:** (563) 564-1283
- **Mailing address:** 8711 WALES RESERVE, SAN ANTONIO, TX 78255-3371
- **Mailing address phone:** (563) 564-1283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2020
- **Last updated:** 05/13/2020