Organization
IHC-BEAVER DAM ANESTHESIA AND PAIN MANAGEMENT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN VAUGHN (OFFICER)
(954) 838-2371
Entity
Organization
Contact information
Practice address
707 S UNIVERSITY AVE, BEAVER DAM, WI 53916-3027
(414) 290-6720
(414) 290-6755
Mailing address
PO BOX 744489, ATLANTA, GA 30374-4489
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
02/13/2009
Last updated
05/04/2023
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