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General NPI Number Information
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NPI Number | 1295478907
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Entity Type | Organization
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Legal Business Name | LAKESIDE PAIN CENTER PROF. LLC
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 1512 4TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-6824
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Country | US
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Telephone | 605-884-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 4TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-6824
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Country | US
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Telephone | 605-884-0100
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AUSTIN J BECK
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Credential | DO
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Telephone | 605-884-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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