Provider Demographics
NPI:1154367407
Name:DEAN HEALTH SYSTEMS, INC.
Entity type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-260-3586
Mailing Address - Street 1:1110 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2044
Mailing Address - Country:US
Mailing Address - Phone:608-643-3333
Mailing Address - Fax:608-644-3852
Practice Address - Street 1:1110 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2044
Practice Address - Country:US
Practice Address - Phone:608-643-3333
Practice Address - Fax:608-644-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053358846Medicaid
WI1053358846Medicaid
WI0419330070Medicare NSC
WI000047805Medicare PIN
WI20390OtherSPECTERA
WI537597OtherDEAN HEALTH INSURANCE
WI3916284910D8OtherBLUE CROSS BLUE SHIELD
WI054014OtherVISION INS PLAN OF AMERIC
WI137082514OtherOFFICE OF WORKERS COMP
WI391628491021OtherTRICARE
WI0419330070Medicare NSC
WICJ4643Medicare PIN