1033248315 NPI number — DEAN HEALTH SYSTEMS, INC.

Table of content: (NPI 1033248315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033248315 NPI number — DEAN HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEAN HEALTH SYSTEMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LANDS END EXPRESS CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033248315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 LANDS END LN
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
DODGEVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53595-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-935-6577
Provider Business Mailing Address Fax Number:
608-935-6500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 LANDS END LN
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
DODGEVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53595-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-935-6577
Provider Business Practice Location Address Fax Number:
608-935-6500
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRINNELL
Authorized Official First Name:
AMY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT - FINANCE
Authorized Official Telephone Number:
608-260-3586

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 391628491293 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 574140 . This is a "DEAN HEALTH INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 391628491086 . This is a "TRICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 32780900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 391628491BL . This is a "WPS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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