Shannon Senior Health Clinic

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

F4722 Issued in TX

Legal business name

SHANNON SENIOR HEALTH CLINIC

Practice address

3016 Vista del Arroyo Dr
San Angelo, TX 76904-6146

Phone

(325) 949-9408

NPI assigned

May 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Irvin Zietler, M.D.

Title

Physician

Phone

(325) 949-9408

Specialties & licenses 1

Addresses

Tax ID family

Senior Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Shannon Rural Health Clinics, Inc

  • Family Medicine Physician
  • San Angelo, TX
  • NPI 1821289539
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194935569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 VISTA DEL ARROYO DR",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769046146",
            "telephone_number": "325-949-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3016 VISTA DEL ARROYO DR",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769046146",
            "telephone_number": "325-949-9408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON SENIOR HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ZIETLER",
        "authorized_official_first_name": "IRVIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "325-949-9408",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "F4722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Medical Center
• Shannon Medical Center
• Shannon Primary Care Clinic
• Shannon Rehabilitation Hospital, LLC
• Shannon Rural Health Clinics, Inc
• Shannon Specialty Care Clinic
• Bethany Dawn Shannon, COTA/L
• Michele Sharon, L.P.C.
• Gayle Sharpsteen, APRN, FNP-C
• Evelyn Shaw, MA

• All providers in San Angelo, TX
• Adult Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.