Provider Demographics
NPI:1073557013
Name:DEAN HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC.
Other - Org Name:SSM HEALTH DEAN MEDICAL GROUP - BEAVER DAM
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 1:705 S UNIVERSITY AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3081
Mailing Address - Country:US
Mailing Address - Phone:920-887-3102
Mailing Address - Fax:920-885-8788
Practice Address - Street 1:705 S UNIVERSITY AVE
Practice Address - Street 2:STE 500
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3081
Practice Address - Country:US
Practice Address - Phone:920-887-3102
Practice Address - Fax:920-885-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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
WI1053358846Medicaid
WI0419330054Medicare NSC
WI1053358846Medicaid
WI000054375Medicare PIN
WICD8126Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI32824600Medicaid
WI0604670016Medicare NSC
WI137082531OtherOFFICE OF WORKERS COMP
WI391628491014OtherTRICARE