Provider Demographics
NPI:1598701781
Name:DEAN HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC.
Other - Org Name:DAVIS DUEHR DEAN PLATTEVILLE
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 1:1450 EASTSIDE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-9800
Mailing Address - Country:US
Mailing Address - Phone:608-342-2020
Mailing Address - Fax:608-342-6330
Practice Address - Street 1:1450 EASTSIDE RD
Practice Address - Street 2:STE 120
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-9800
Practice Address - Country:US
Practice Address - Phone:608-342-2020
Practice Address - Fax:608-342-6330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
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
WI38714900Medicaid
WI0419330080Medicare NSC
WI000047805Medicare PIN
WI11000OtherNATIONAL VISION ADMINISTR
WI555549OtherDEAN HEALTH INSURANCE
WICJ4643Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI0604670021Medicare NSC
WI20386OtherSPECTERA
WI391628491043OtherTRICARE
WI391628491139OtherBLUE CROSS BLUE SHIELD
WI137082510OtherOFFICE OF WORKERS COMP
WI391628491AIOtherWPS