Provider Demographics
NPI:1275579849
Name:DEAN HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC.
Other - Org Name:SSM HEALTH DAVIS DUEHR DEAN EYE CARE - DODGEVILLE
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 1:305 ELAINES CT
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-2103
Mailing Address - Country:US
Mailing Address - Phone:608-930-4362
Mailing Address - Fax:608-930-4366
Practice Address - Street 1:305 ELAINES CT
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-2103
Practice Address - Country:US
Practice Address - Phone:608-930-4362
Practice Address - Fax:608-930-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053358846Medicaid
WI1053358846Medicaid
WI0419330063Medicare NSC
WI391628491278OtherBLUE CROSS BLUE SHIELD
WI391628491067OtherTRICARE
WI20369OtherSPECTERA
WI137082504OtherOFFICE OF WORKERS COMP
WI19719OtherNATIONAL VISION ADMINISTR
WI38720600Medicaid
WI0604670041Medicare NSC
WI000047805Medicare PIN
WI054014OtherVISION INS PLAN OF AMERIC