Healthcare Provider Details

I. General information

NPI: 1114987963
Provider Name (Legal Business Name): SHANNON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 PULLIAM ST
SAN ANGELO TX
76905-5148
US

IV. Provider business mailing address

PO BOX 1879
SAN ANGELO TX
76902-1879
US

V. Phone/Fax

Practice location:
  • Phone: 325-657-5031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS PATRICIA KIRKHAM
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 325-657-5031