MEDICARE: INNOVATIVE PROCEDURAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	51560	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00188503	OTHER	SD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4N38IN	OTHER	MN	BCBS - GROUP
3	81020	OTHER	SD	BCBS - GROUP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184660151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE PROCEDURAL CENTER LLC

Provider Business Mailing Address
First Line	:	1512 4TH ST NE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-6824
Country	:	US
Telephone Number	:	605-884-0100
Fax Number	:	605-753-0017

Provider Business Practice Location Address
First Line	:	1512 4TH ST NE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-6824
Country	:	US
Telephone Number	:	605-884-0100
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	AUSTIN J BECK
Credential	:	DO
Telephone Number	:	605-884-0100

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/17/2025

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Directions to “INNOVATIVE PROCEDURAL CENTER LLC ” Practice Location

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