Provider Demographics
NPI:1093751653
Name:ST. MARYS DEAN VENTURES INC.
Entity Type:Organization
Organization Name:ST. MARYS DEAN VENTURES INC.
Other - Org Name:DAVIS DUEHR DEAN BOSCOBEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICE
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 1:310 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1633
Mailing Address - Country:US
Mailing Address - Phone:608-375-6001
Mailing Address - Fax:608-375-6011
Practice Address - Street 1:310 PARKER ST
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1633
Practice Address - Country:US
Practice Address - Phone:608-375-6001
Practice Address - Fax:608-375-6011
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
WI22649OtherNATIONAL VISION ADMINISTR
WI570986OtherDEAN HEALTH INSURANCE
WI054014OtherVISION INS PLAN OF AMERIC
WI28845OtherSPECTERA
WI137082538OtherOFFICE OF WORKERS COMP
WI38723700Medicaid
WI=========004OtherTRICARE
WI054014OtherVISION INS PLAN OF AMERIC
WI22649OtherNATIONAL VISION ADMINISTR
WI=========AIOtherWPS
WI054014OtherVISION INS PLAN OF AMERIC
WI38723700Medicaid