Provider Demographics
NPI:1427085679
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 1:2825 HUNTERS TRL
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-3429
Mailing Address - Country:US
Mailing Address - Phone:608-742-5522
Mailing Address - Fax:608-745-3054
Practice Address - Street 1:2825 HUNTERS TRL
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-3429
Practice Address - Country:US
Practice Address - Phone:608-742-5522
Practice Address - Fax:608-745-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
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
WI000074150Medicare PIN
WI0419330083Medicare NSC
WICJ4643Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI000047810Medicare PIN
WI391628491AIOtherWPS
WI14698OtherNATIONAL VISION ADMINISTR
WI20387OtherSPECTERA
WI38715400Medicaid
WI391628491154OtherBLUE CROSS BLUE SHIELD
WI137082511OtherOFFICE OF WORKERS COMP
WI556775OtherDEAN HEALTH INSURANCE