Organization
JEFFERSON LAKE 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
1373 E STATE ROAD 62, MADISON, IN 47250-7328
(812) 801-0800
Mailing address
PO BOX 37979, PHILADELPHIA, PA 19101-0579
(954) 838-2371
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/29/2013
Last updated
03/30/2023
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