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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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