Provider Demographics
NPI:1255694295
Name:PREMIER PAYEE
Entity Type:Organization
Organization Name:PREMIER PAYEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-947-4061
Mailing Address - Street 1:279 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:LACONA
Mailing Address - State:IA
Mailing Address - Zip Code:50139-8535
Mailing Address - Country:US
Mailing Address - Phone:641-947-4061
Mailing Address - Fax:
Practice Address - Street 1:279 PERRY ST
Practice Address - Street 2:
Practice Address - City:LACONA
Practice Address - State:IA
Practice Address - Zip Code:50139-8535
Practice Address - Country:US
Practice Address - Phone:641-947-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services