Healthcare Provider Details

I. General information

NPI: 1184660151
Provider Name (Legal Business Name): INNOVATIVE PROCEDURAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 4TH ST NE
WATERTOWN SD
57201-6824
US

IV. Provider business mailing address

1512 4TH ST NE
WATERTOWN SD
57201-6824
US

V. Phone/Fax

Practice location:
  • Phone: 605-884-0100
  • Fax:
Mailing address:
  • Phone: 605-884-0100
  • Fax: 605-753-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number51560
License Number StateSD

VIII. Authorized Official

Name: AUSTIN J BECK
Title or Position: OWNER/PROVIDER
Credential: DO
Phone: 605-884-0100