Provider Demographics
NPI:1144392275
Name:ST MARY'S DEAN VENTURES INC
Entity Type:Organization
Organization Name:ST MARY'S DEAN VENTURES INC
Other - Org Name:BREAST CORE BIOPSY CENTER
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:PO BOX 259317
Mailing Address - Street 2:1808 W BELTLINE HWY
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53725-9317
Mailing Address - Country:US
Mailing Address - Phone:608-250-1316
Mailing Address - Fax:608-250-1034
Practice Address - Street 1:1313 FISH HATCHERY ROAD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715
Practice Address - Country:US
Practice Address - Phone:608-252-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI543668OtherDEAN HEALTH PLAN
WI32837200Medicaid
WI32837200Medicaid
WI490001244Medicare PIN