Organization
INNOVATIVE PAIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK L RETTERATH MD (PROVIDER)
(605) 884-0100
Entity
Organization
Contact information
Practice address
1512 4TH ST NE, WATERTOWN, SD 57201-6824
(605) 884-0100
Mailing address
1201 MICKELSON DR STE 2, WATERTOWN, SD 57201-7253
(605) 882-0432
(605) 882-0978
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
0425
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4995163
BCBS
SD
01
—
73M96IN
BCBS
MN
05
—
892980000
—
MN
Enumeration date
06/20/2006
Last updated
12/22/2010
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