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General NPI Number Information
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NPI Number | 1225031446
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Entity Type | Organization
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Legal Business Name | SHANNON MEDICAL CENTER
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 3555 KNICKERBOCKER RD STE 21
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City | SAN ANGELO
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State | TX
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Zip | 76904-7610
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Country | US
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Telephone | 325-747-7480
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Fax | 325-747-7497
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Provider Business Mailing Address
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Address Line | 3555 KNICKERBOCKER RD STE 21
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City | SAN ANGELO
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State | TX
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Zip | 76904-7610
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Country | US
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Telephone | 325-747-7480
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Fax | 325-747-7497
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Authorized Official
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Title or Position | CFO
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Name | JOSEPH WOOLDRIDGE
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Credential |
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Telephone | 325-657-8212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 003134
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License Number State | TX
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