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General NPI Number Information
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NPI Number | 1770587149
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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 | 06/13/2005
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 120 E BEAUREGARD AVE
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City | SAN ANGELO
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State | TX
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Zip | 76903-5919
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Country | US
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Telephone | 325-658-1511
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Fax | 325-481-2166
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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 | 325-658-1511
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Fax |
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Authorized Official
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Title or Position | COO
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Name | RICARDO VILLARREAL
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Credential |
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Telephone | 325-747-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | TX
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Taxonomy #8
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State | TX
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Taxonomy #9
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | TX
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Taxonomy #10
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | TX
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Taxonomy #11
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Taxonomy Code | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number |
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License Number State | TX
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Taxonomy #12
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | TX
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Taxonomy #13
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | TX
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Taxonomy #14
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | TX
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Taxonomy #15
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | TX
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