MEDICARE: SHANNON CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1003762899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNON CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 22000
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76902-7200
Country	:	US
Telephone Number	:	325-747-1511
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 S GREGG ST STE C
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-6583
Country	:	US
Telephone Number	:	432-606-5178
Fax Number	:	432-606-5066

Authorized Official
Title or Position	:	CAO
Name	:	RICARDO VILLARREAL
Credential	:
Telephone Number	:	325-481-2200

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/06/2026

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Directions to “SHANNON CLINIC ” Practice Location

Language	Start Address	Practice Location

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