NPIMap

Organization Active NPI

Shannon Clinic RP

  • Diagnostic Radiology Physician
  • San Angelo, TX
National Provider Identifier
1285818849
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SHANNON CLINIC RP
Practice address
120 E Beauregard Ave
San Angelo, TX 76903-5919
Phone
(325) 658-1511
NPI assigned
Dec 19, 2007
Last updated
Jan 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

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

Authorized official

Name
Ricardo Villarreal
Title
Cao
Phone
(325) 481-8248

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X NU
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

120 E Beauregard Ave
San Angelo, TX 76903-5919

Mailing address

PO Box 90259
San Angelo, TX 76902-8059
Phone (325) 658-1511

Other identifiers 1

IdentifierTypeStateIssuer
0057QQOtherTXBCBS GROUP

National Provider Directory

National Provider Directory
Tax ID family
Shannon Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1285818849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 90259",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769028059",
            "telephone_number": "325-658-1511",
            "fax_number": "325-659-0180"
        },
        {
            "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 RP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "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": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "0057QQ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.