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Contact Information

INNOVATIVE PAIN CENTER LLC
1512 4TH ST NE
WATERTOWN, SD57201-6824
 Phone: 605-884-0100
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

NPI Profile & details for INNOVATIVE PAIN CENTER LLC · (Female)

NPI # 1003851163
Status Active
Credentials
Entity Individual
Enumeration date 06/20/2006
Last updated 12/22/2010 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • SD License # 0425
  • MN Medicaid 892980000
  • MN Other 73M96IN BCBS
  • SD Other 4995163 BCBS
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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