Provider Demographics
NPI:1497791057
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 1:1104 21ST ST
Mailing Address - Street 2:STE F
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1022
Mailing Address - Country:US
Mailing Address - Phone:608-524-4303
Mailing Address - Fax:608-524-4028
Practice Address - Street 1:1104 21ST ST
Practice Address - Street 2:STE F
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1022
Practice Address - Country:US
Practice Address - Phone:608-524-4303
Practice Address - Fax:608-524-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
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
WI0419330082Medicare NSC
WICJ4643Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI391628491064OtherTRICARE
WI10672OtherNATIONAL VISION ASMINISTR
WI137082512OtherOFFICE OF WORKERS COMP
WI0604670037Medicare NSC
WI054014OtherVISION INS PLAN OF AMERIC
WI565051OtherDEAN HEALTH INSURANCE
WI0000747805Medicare PIN
WI38720000Medicaid