MEDICARE: SHANNON CORRINE HILL PROSTHETIC PROVIDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1194599530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON CORRINE HILL PROSTHETIC PROVIDER

Provider Business Mailing Address
First Line	:	4714 SHAVANO OAK STE 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4029
Country	:	US
Telephone Number	:	210-872-6511
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 SHAVANO OAK STE 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4029
Country	:	US
Telephone Number	:	210-872-6511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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Directions to “ SHANNON CORRINE HILL PROSTHETIC PROVIDER” Practice Location

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