Provider Demographics
NPI:1235201369
Name:DEAN HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC.
Other - Org Name:SSM HEALTH SURGERY CENTER
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 1:1025 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1248
Mailing Address - Country:US
Mailing Address - Phone:608-282-2050
Mailing Address - Fax:608-282-2058
Practice Address - Street 1:1025 REGENT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1248
Practice Address - Country:US
Practice Address - Phone:608-282-2050
Practice Address - Fax:608-282-2058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41908800Medicaid
WI490003046Medicare PIN
WIK300225823Medicare PIN
WI41908800Medicaid