Provider Demographics
NPI:1083650642
Name:ST. MARYS DEAN VENTURES INC.
Entity Type:Organization
Organization Name:ST. MARYS DEAN VENTURES INC.
Other - Org Name:DAVIS DUEHR DEAN JEFFERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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 1:144 W GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-2029
Mailing Address - Country:US
Mailing Address - Phone:920-674-2217
Mailing Address - Fax:920-674-6030
Practice Address - Street 1:144 W GARLAND ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-2029
Practice Address - Country:US
Practice Address - Phone:920-674-2217
Practice Address - Fax:920-674-6030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARYS DEAN VENTURES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI137082506OtherOFFICE OF WORKERS COMP
WI557381OtherDEAN HEALTH INSURANCE
WI054014OtherVISION INS PLAN OF AMERIC
WI14680OtherNATIONAL VISION ADMINISTR
WI20382OtherSPECTERA
WI38715900Medicaid
WI=========AIOtherWPS
WI38715900Medicaid
WI137082506OtherOFFICE OF WORKERS COMP
WI=========AIOtherWPS
WI=========162OtherBLUE CROSS BLUE SHIELD
WI557381OtherDEAN HEALTH INSURANCE