Provider Demographics
NPI:1073558045
Name:DEAN HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC.
Other - Org Name:SSM HEALTH DEAN MEDICAL GROUP - EDGERTON
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 1:11051 N SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9002
Mailing Address - Country:US
Mailing Address - Phone:608-884-3354
Mailing Address - Fax:608-884-5022
Practice Address - Street 1:11051 N SHERMAN RD
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-9002
Practice Address - Country:US
Practice Address - Phone:608-884-3354
Practice Address - Fax:608-884-5022
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
WI0419330078Medicare NSC
WI000074150Medicare PIN
WI391628491170OtherBLUE CROSS BLUE SHIELD
WI391628491035OtherTRICARE
WIN77OtherDEAN HEALTH INSURANCE
WI0419330078Medicare NSC
WI32882300Medicaid
WI32882300Medicaid