Healthcare Provider Details

I. General information

NPI: 1124806146
Provider Name (Legal Business Name): EPIC PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8522 BROADWAY STE 216
SAN ANTONIO TX
78217-6456
US

IV. Provider business mailing address

202 ASHLING
SAN ANTONIO TX
78260-3508
US

V. Phone/Fax

Practice location:
  • Phone: 210-874-5260
  • Fax:
Mailing address:
  • Phone: 305-342-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WANDA NORGARD
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 512-665-3788