Organization
IHC-ST. NICHOLAS EMERGENCY PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN VAUGHN (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
3100 SUPERIOR AVE, SHEBOYGAN, WI 53081-1948
(414) 290-6718
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6718
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020447000
FEDERAL BLACK LUNG PROGRA
WI
01
—
125362001
OWCP
WI
01
—
130007874
WEA
WI
05
—
21267500
—
WI
01
—
DA1626
MEDICARE RAILROAD
WI
Enumeration date
05/05/2006
Last updated
03/30/2023
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