INNOVATIVE PAIN CENTER LLC NPI 1003851163

NPI Information

  • NPI: 1003851163
  • Provider Name: INNOVATIVE PAIN CENTER LLC
  • Classification: Pain Medicine - 208VP0014X
  • Specialization: Interventional Pain Medicine
  • Entity Type: Organization
  • Address: 1512 4TH ST NE
    WATERTOWN, SD
    ZIP 57201
  • Phone: (605) 884-0100

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NPI Details

INNOVATIVE PAIN CENTER LLC is an interventional pain medicine pain medicine in Watertown, SD. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. INNOVATIVE PAIN CENTER LLC NPI is 1003851163. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1512 4TH ST NE
WATERTOWN, SD
ZIP 57201-824
Phone: (605) 884-0100

The provider's authorized official is Patrick L Retterath .
The authorized official title is Provider and has the following contact phone number (605) 884-0100.

The enumeration date for this NPI number is 6/20/2006 and was last updated on 12/22/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208VP0014XPain MedicineInterventional Pain Medicine0425SOUTH DAKOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1C03455MEDICARE ID-TYPE UNSPECIFIEDMINNESOTAGROUP
26323830001MEDICARE NSCSOUTH DAKOTA
373M96INOTHERMINNESOTABCBS
4892980000MEDICAIDMINNESOTA
54995163OTHERSOUTH DAKOTABCBS
6DC7594MEDICARE ID-TYPE UNSPECIFIEDSOUTH DAKOTARAILROAD
7S41717MEDICARE PINSOUTH DAKOTA

What is NPI?

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This page was last updated on: 11/21/2025

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