Provider Demographics
NPI:1417993072
Name:ST. MARYS DEAN VENTURES INC.
Entity Type:Organization
Organization Name:ST. MARYS DEAN VENTURES INC.
Other - Org Name:DAVIS DUEHR DEAN MONTELLO
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 1:215B CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-9763
Mailing Address - Country:US
Mailing Address - Phone:608-297-2501
Mailing Address - Fax:608-297-2648
Practice Address - Street 1:215B CHURCH ST
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-9763
Practice Address - Country:US
Practice Address - Phone:608-297-2501
Practice Address - Fax:608-297-2648
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
WI38715400Medicaid
WI556775OtherDEAN HEALTH INSURANCE
WI137082509OtherOFFICE OF WORKERS COMP
WI14699OtherNATIONAL VISION ADMINISTR
WI20385OtherSPECTERA
WI054014OtherVISION INS PLAN OF AMERIC
WI=========154OtherBLUE CROSS BLUE SHIELD
WI=========AZOtherWPS
WI38715400Medicaid
WI=========AZOtherWPS