Organization
ST. MARYS DEAN VENTURES INC.
Active
Parent organization
ST. MARYS DEAN VENTURES INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARYS DEAN VENTURES INC.
Authorized official
AMY J GRINNELL (CHIEF FINANCIAL OFFICER)
(608) 260-3586
Entity
Organization
Contact information
Practice address
1700 TUTTLE ST, BARABOO, WI 53913-3319
(888) 968-4681
(608) 355-7001
Mailing address
1305 W MAIN ST, WHITEWATER, WI 53190-1503
(262) 472-7686
(262) 472-7691
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
WI
261QM1300X
Multi-Specialty Clinic/Center
—
WI
261QR0200X
Radiology Clinic/Center
—
WI
261QR0206X
Mammography Clinic/Center
—
WI
291U00000X
Clinical Medical Laboratory
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0592394
—
IA
05
—
200232380A
—
IN
05
—
200403240A
—
IN
05
—
32780900
—
WI
05
—
32824600
—
WI
05
—
32829800
—
WI
05
—
32882300
—
WI
05
—
5E293GR
—
MN
Enumeration date
05/31/2006
Last updated
10/29/2021
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