Provider Demographics
NPI:1033248315
Name:DEAN HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC.
Other - Org Name:LANDS END EXPRESS CLINIC
Other - Org Type:Doing Business As
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 1:9 LANDS END LN
Mailing Address - Street 2:STE 1
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53595-0001
Mailing Address - Country:US
Mailing Address - Phone:608-935-6577
Mailing Address - Fax:608-935-6500
Practice Address - Street 1:9 LANDS END LN
Practice Address - Street 2:STE 1
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53595-0001
Practice Address - Country:US
Practice Address - Phone:608-935-6577
Practice Address - Fax:608-935-6500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391628491293OtherBLUE CROSS BLUE SHIELD
WI574140OtherDEAN HEALTH INSURANCE
WI391628491086OtherTRICARE
WI32780900Medicaid
WI391628491BLOtherWPS
WI391628491BLOtherWPS
WI391628491086OtherTRICARE