Provider Demographics
NPI:1083622278
Name:DEAN HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC.
Other - Org Name:SSM HEALTH DEAN MEDICAL GROUP SPECIALTY SERVICES - COLUMBUS
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 1:1513 PARK AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1793
Mailing Address - Country:US
Mailing Address - Phone:920-623-9535
Mailing Address - Fax:920-623-6330
Practice Address - Street 1:1513 PARK AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1793
Practice Address - Country:US
Practice Address - Phone:920-623-9535
Practice Address - Fax:920-623-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
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
WI1053358846Medicaid
WI000074150Medicare PIN
WI1053358846Medicaid