Active NPI
Shannon Medical Center
- Skilled Nursing Facility
- San Angelo, TX
National Provider Identifier
1114987963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- SHANNON MEDICAL CENTER
- Practice address
- 2018 Pulliam St
San Angelo, TX 76905-5148 - Phone
- (325) 657-5031
- NPI assigned
- Mar 24, 2006
- Last updated
- Aug 26, 2011
- Organization subpart
- Yes
- Parent organization
- SHANNON MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Miss Patricia Kirkham
- Title
- Billing Supervisor
- Phone
- (325) 657-5031
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
2018 Pulliam St
San Angelo, TX 76905-5148
Mailing address
PO Box 1879
San Angelo, TX 76902-1879
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HH2625 | Other | TX | BLUE CROSS SNF |
| 000916102 | Medicaid | TX |
National Provider Directory
National Provider Directory- Part of
- Shannon Air Med 1
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1314316800000",
"number": "1114987963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1879",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769021879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2018 PULLIAM ST",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769055148",
"telephone_number": "325-657-5031"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHANNON MEDICAL CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SHANNON MEDICAL CENTER",
"enumeration_date": "2006-03-24",
"last_updated": "2011-08-26",
"status": "A",
"authorized_official_last_name": "KIRKHAM",
"authorized_official_first_name": "PATRICIA",
"authorized_official_title_or_position": "BILLING SUPERVISOR",
"authorized_official_telephone_number": "325-657-5031",
"authorized_official_name_prefix": "Miss"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS SNF",
"identifier": "HH2625",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000916102",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
- Shannon Clinic Reference Lab
- Shannon Clinic RP
- Shannon Joint Ventures, Inc (Shannon Dialysis Center)
- Shannon Medical Center
- Shannon Medical Center
- Shannon Medical Center (Shannon Home Health Services)
- Shannon Medical Center
- Shannon Medical Center
- Shannon Medical Center
- Shannon Medical Center (Shannon Medical Center - Outpatient Dialysis Facility)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.