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General NPI Number Information
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NPI Number | 1003762899
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Entity Type | Organization
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Legal Business Name | SHANNON CLINIC
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 2503 S GREGG ST STE C
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City | BIG SPRING
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State | TX
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Zip | 79720-6583
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Country | US
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Telephone | 432-606-5178
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Fax | 432-606-5066
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Provider Business Mailing Address
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Address Line | PO BOX 22000
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City | SAN ANGELO
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State | TX
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Zip | 76902-7200
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Country | US
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Telephone | 325-747-1511
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Fax |
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Authorized Official
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Title or Position | CAO
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Name | RICARDO VILLARREAL
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Credential |
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Telephone | 325-481-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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