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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

NPI Number 1003851163
LBN Legal business name INNOVATIVE PAIN CENTER LLC
Authorized official PATRICK RETTERATH - (PROVIDER)
Entity Organization
Organization subpart 1 No
Enumeration date 06/20/2006
Last updated 12/22/2010 - About 15 years ago
Identifiers
SD License # 0425
MN Medicaid 892980000
MN Other 73M96IN BCBS
SD Other 4995163 BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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