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NPI Code Detail

MEDICARE: SHANNON MEDICAL CENTER

MEDICARE: SHANNON MEDICAL CENTER
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
1251E00000XHome Health Agency003134TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24557949OTHERTXAETNA
3HH9647OTHERTXBLUE CROSS

General Provider Information

NPI Number : 1225031446
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHANNON MEDICAL CENTER
Provider Business Mailing Address
First Line : 3555 KNICKERBOCKER RD STE 21
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-7610
Country : US
Telephone Number : 325-747-7480
Fax Number : 325-747-7497
Provider Business Practice Location Address
First Line : 3555 KNICKERBOCKER RD STE 21
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-7610
Country : US
Telephone Number : 325-747-7480
Fax Number : 325-747-7497
Authorized Official
Title or Position : CFO
Name : JOSEPH WOOLDRIDGE
Credential :
Telephone Number : 325-657-8212
Provider Enumeration Date : 05/23/2005
Last Update Date : 08/02/2023

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Directions to “SHANNON MEDICAL CENTER ” Practice Location

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