Shannon Clinic Reference Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SHANNON CLINIC REFERENCE LAB

Practice address

120 E Beauregard Ave
San Angelo, TX 76903-5919

Phone

(325) 658-1511

NPI assigned

Aug 13, 2007

Organization subpart

No

Name

Ricardo Villarreal

Title

Cao

Phone

(325) 481-8248

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 21, 2020.

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1114119385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E BEAUREGARD AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035919",
            "telephone_number": "325-658-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON CLINIC REFERENCE LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "VILLARREAL",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "325-481-8248"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127005001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Clinic
• Shannon Clinic
• Shannon Clinic
• Shannon Clinic
• Shannon Clinic
• Shannon Clinic RP
• Shannon Joint Ventures, Inc
• Shannon Medical Center
• Shannon Medical Center
• Shannon Medical Center

• All providers in San Angelo, TX
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.