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General NPI Number Information
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NPI Number | 1699016337
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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 | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 2008 NINE RD
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City | BRADY
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State | TX
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Zip | 76825-7210
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Country | US
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Telephone | 325-597-2901
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Fax |
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Provider Business Mailing Address
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Address Line | 120 E HARRIS AVE
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City | SAN ANGELO
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State | TX
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Zip | 76903-5904
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRYAN HORNER
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Credential |
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Telephone | 325-657-8266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | APPLIED FOR
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License Number State | TX
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