1710921838 NPI number — ST. MARYS DEAN VENTURES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710921838 NPI number — ST. MARYS DEAN VENTURES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARYS DEAN VENTURES 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:
Provider Other Organization Name Type Code:
6
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:
1710921838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POYNETTE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53955-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-635-4343
Provider Business Mailing Address Fax Number:
608-635-7094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 W SEWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POYNETTE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53955-9584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-635-4343
Provider Business Practice Location Address Fax Number:
608-635-7094
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

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

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

  • Identifier: 32829800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137082533 . This is a "OFFICE OF WORKERS COMP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: M13 . This is a "DEAN HEALTH INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com