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General NPI Number Information
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NPI Number | 1710921838
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Entity Type | Organization
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Legal Business Name | ST. MARYS DEAN VENTURES INC.
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 237 W SEWARD ST
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City | POYNETTE
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State | WI
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Zip | 53955-9584
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Country | US
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Telephone | 608-635-4343
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Fax | 608-635-7094
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Provider Business Mailing Address
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Address Line | PO BOX 97
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City | POYNETTE
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State | WI
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Zip | 53955-0097
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Country | US
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Telephone | 608-635-4343
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Fax | 608-635-7094
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | AMY J GRINNELL
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Credential |
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Telephone | 608-260-3586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | WI
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Legacy Identifiers
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Identifier #1
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Identifier Code | 32829800
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Identifier Type | MEDICAID
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Identifier State | WI
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Identifier Issuer |
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Identifier #2
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Identifier Code | 137082533
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Identifier Type | OTHER
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Identifier State | WI
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Identifier Issuer | OFFICE OF WORKERS COMP
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Identifier #3
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Identifier Code | M13
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Identifier Type | OTHER
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Identifier State | WI
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Identifier Issuer | DEAN HEALTH INSURANCE
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 137082533
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Identifier Type | OTHER
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Identifier State | WI
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Identifier Issuer | OFFICE OF WORKERS COMP
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Identifier #2
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Identifier Code | 32829800
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Identifier Type | MEDICAID
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Identifier State | WI
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Identifier Issuer |
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Identifier #3
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Identifier Code | M13
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Identifier Type | OTHER
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Identifier State | WI
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Identifier Issuer | DEAN HEALTH INSURANCE
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