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	332B00000X	Durable Medical Equipment & Medical Supplies		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137082522	OTHER	WI	OFFICE OF WORKERS COMP
2	N48	OTHER	WI	DEAN HEALTH INSURANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487698353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARYS DEAN VENTURES INC.

Provider Business Mailing Address
First Line	:	207 E SKELLY ST
Second Line	:
City	:	CUBA CITY
State	:	WI
Zip	:	53807-1453
Country	:	US
Telephone Number	:	608-744-2767
Fax Number	:	608-744-3578

Provider Business Practice Location Address
First Line	:	207 E SKELLY ST
Second Line	:
City	:	CUBA CITY
State	:	WI
Zip	:	53807-1453
Country	:	US
Telephone Number	:	608-744-2767
Fax Number	:	608-744-3578

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	10/29/2021

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