St. Marys Dean Ventures Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ST. MARYS DEAN VENTURES INC.

Doing business as

WAUPUN CLINIC

Practice address

612 W Brown St
Waupun, WI 53963-1702

Phone

(920) 324-5043

Fax

(920) 324-6768

NPI assigned

Jun 16, 2006

Organization subpart

Yes

Parent organization

ST. MARYS DEAN VENTURES INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy J Grinnall

Title

Chief Financial Office

Phone

(608) 260-3586

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• WAUPUN CLINIC Doing business as

Part of

Evansville Clinic

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Memorial Hospital of Boscobel

  • Rural Health Clinic/Center
  • Fennimore, WI
  • NPI 1437448891

  Member Of

  NPD member
• SSM Health Care of Wisconsin Inc

  • Certified Registered Nurse Anesthetist
  • Baraboo, WI
  • NPI 1336120401

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1164467130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 W BROWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631702",
            "telephone_number": "920-324-5043",
            "fax_number": "920-324-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 W BROWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631702",
            "telephone_number": "920-324-5043",
            "fax_number": "920-324-6768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARYS DEAN VENTURES INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARYS DEAN VENTURES INC.",
        "enumeration_date": "2006-06-16",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "GRINNALL",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICE",
        "authorized_official_telephone_number": "608-260-3586"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE OF WORKERS COMP",
            "identifier": "137082535",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH INSURANCE",
            "identifier": "N65",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32824600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAUPUN CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WAUPUN CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Senior Community Center Management of Waupun, LLC
• Manish Sharda, DO
• Lynnae Shaw, RN BSN NCSN
• Stephen Slattery
• Andrea Marie Smits, APNP
• Olly Christian Stewart, PT, DPT
• Kathryn Therese Sullivan Dillie, MD, PHD
• Jessica Y Sullivan, NP
• Paul Henry Sumnicht, M.D.
• Tammy Narance LPC SC

• Durable Medical Equipment & Medical Supplies in Waupun, WI
• Providers in Waupun, WI by specialty
• Durable Medical Equipment & Medical Supplies in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.