Provider Demographics
NPI:1740224997
Name:DEAN HEALTH SYSTEMS, INC,
Entity Type:Organization
Organization Name:DEAN HEALTH SYSTEMS, INC,
Other - Org Name:DEAN CLINIC - BARNEVELD
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 1:103 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9408
Mailing Address - Country:US
Mailing Address - Phone:608-924-3939
Mailing Address - Fax:608-924-3999
Practice Address - Street 1:103 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:WI
Practice Address - Zip Code:53507-9408
Practice Address - Country:US
Practice Address - Phone:608-924-3939
Practice Address - Fax:608-924-3999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
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
WI391628491AVOtherWPS
WI32780900Medicaid
WI391628491066OtherTRICARE
WI391628491261OtherBLUE CROSS BLUE SHIELD
WIP19OtherDEAN HEALTH INSURANCE
WI137082525OtherOFFICE OF WORKERS COMP
WI32780900Medicaid
WI0604670038Medicare NSC
WICD8126Medicare ID - Type UnspecifiedRAILROAD MEDICARE