NPIMap

Organization Active NPI

Shannon Clinic

Doing business as Shannon Clinic Orthotics

  • Prosthetic/Orthotic Supplier
  • San Angelo, TX
National Provider Identifier
1285954396
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
1210 Issued in TX
Legal business name
SHANNON CLINIC
Doing business as
Shannon Clinic Orthotics
Practice address
110 E Twohig Ave
San Angelo, TX 76903-5916
Phone
(325) 653-9235
Fax
(325) 653-9284
NPI assigned
Jun 11, 2010
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X 1210 TX Primary

Addresses

Primary practice location

110 E Twohig Ave
San Angelo, TX 76903-5916

Mailing address

PO Box 22000
San Angelo, TX 76902-7200
Phone (325) 658-1511

Other names 1

  • SHANNON CLINIC ORTHOTICS Doing business as

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.

Locations

110 E Twohig Ave
San Angelo, TX 76903
Phone (325) 653-9235

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1285954396",
    "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",
            "fax_number": "325-659-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E TWOHIG AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035916",
            "telephone_number": "325-653-9235",
            "fax_number": "325-653-9284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-11",
        "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": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TX",
            "license": "1210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHANNON CLINIC ORTHOTICS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SHANNON CLINIC ORTHOTICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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.