Provider Demographics
NPI:1811931942
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 1:1513 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1618
Mailing Address - Country:US
Mailing Address - Phone:920-623-9611
Mailing Address - Fax:920-623-1788
Practice Address - Street 1:1513 PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1618
Practice Address - Country:US
Practice Address - Phone:920-623-9611
Practice Address - Fax:920-623-1788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
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
WI391628491227OtherBLUE CROSS BLUE SHIELD
WI32824600Medicaid
WI391628491056OtherTRICARE
WI391628491APOtherWPS
WI137082519OtherOFFICE OF WORKERS COMP
WIP12OtherDEAN HEALTH INSURANCE
WI0604670031Medicare NSC
WIP12OtherDEAN HEALTH INSURANCE
WI32824600Medicaid