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1568494466

NPI Code Detail

MEDICARE: ST. MARYS DEAN VENTURES INC.

MEDICARE: ST. MARYS DEAN VENTURES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center		WI
2	261QM1300X	Multi-Specialty Clinic/Center		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568494466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARYS DEAN VENTURES INC.

Provider Business Mailing Address
First Line	:	1626 TUTTLE ST
Second Line	:	SUITE 1
City	:	BARABOO
State	:	WI
Zip	:	53913-1501
Country	:	US
Telephone Number	:	608-356-2020
Fax Number	:	608-356-6787

Provider Business Practice Location Address
First Line	:	1626 TUTTLE ST
Second Line	:	SUITE 1
City	:	BARABOO
State	:	WI
Zip	:	53913-1501
Country	:	US
Telephone Number	:	608-356-2020
Fax Number	:	608-356-6787

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICE
Name	:	AMY J GRINNELL
Credential	:
Telephone Number	:	608-260-3586

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/29/2021

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Directions to “ST. MARYS DEAN VENTURES INC. ” Practice Location

Language	Start Address	Practice Location

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