# SHANNON MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SHANNON MEDICAL CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1114987963
- **Legal business name:** SHANNON MEDICAL CENTER
- **Authorized official:** MISS PATRICIA KIRKHAM (BILLING SUPERVISOR)
- **Authorized official phone:** (325) 657-5031

## Contact information

- **Practice address:** 2018 PULLIAM ST, SAN ANGELO, TX 76905-5148
- **Practice address phone:** (325) 657-5031
- **Mailing address:** PO BOX 1879, SAN ANGELO, TX 76902-1879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 03/24/2006
- **Last updated:** 08/26/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000916102 | — | TX |
| 01 | — | HH2625 | BLUE CROSS SNF | TX |