SHANNON CLINIC NPI 1770587149

NPI Information

NPI: 1770587149
Provider Name: SHANNON CLINIC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
120 E BEAUREGARD AVE
SAN ANGELO, TX
ZIP 76903
Phone: (325) 658-1511
Get Directions

SHANNON CLINIC is a family medicine in San Angelo, TX. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SHANNON CLINIC NPI is 1770587149. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

120 E BEAUREGARD AVE
SAN ANGELO, TX
ZIP 76903-919
Phone: (325) 658-1511
Fax: (325) 481-2166

The provider's authorized official is Ricardo Villarreal .
The authorized official title is Coo and has the following contact phone number (325) 481-2200.

The enumeration date for this NPI number is 6/13/2005 and was last updated on 1/18/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	207K00000X	Allergy & Immunology		TEXAS	No
2	207KA0200X	Allergy & Immunology	Allergy	TEXAS	No
3	207L00000X	Anesthesiology		TEXAS	No
4	207N00000X	Dermatology		TEXAS	No
5	207R00000X	Internal Medicine		TEXAS	No
6	207T00000X	Neurological Surgery		TEXAS	No
7	207V00000X	Obstetrics & Gynecology		TEXAS	No
8	207W00000X	Ophthalmology		TEXAS	No
9	207X00000X	Orthopaedic Surgery		TEXAS	No
10	207Y00000X	Otolaryngology		TEXAS	No
11	207ZB0001X	Pathology	Blood Banking & Transfusion Medicine	TEXAS	No
12	208000000X	Pediatrics		TEXAS	No
13	2085R0202X	Radiology	Diagnostic Radiology	TEXAS	No
14	208600000X	Surgery		TEXAS	No
15	207Q00000X	Family Medicine		TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	127005002	OTHER	TEXAS	CSHCN
2	CL8387	OTHER	TEXAS	MEDICARE PTAN
3	127005001	MEDICAID	TEXAS
4	00T83Z	OTHER	TEXAS	MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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