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Organization
SHANNON MEDICAL CENTER
Active
Organization
SHANNON MEDICAL CENTER
Active
Other names
SHANNON HOME HEALTH SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH WOOLDRIDGE (CFO)
(325) 657-8212
Entity
Organization
Contact information
Practice address
3555 KNICKERBOCKER RD STE 21, SAN ANGELO, TX 76904-7610
(325) 747-7480
(325) 747-7497
Mailing address
3555 KNICKERBOCKER RD STE 21, SAN ANGELO, TX 76904-7610
(325) 747-7480
(325) 747-7497
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
003134
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023709101
—
TX
01
—
4557949
AETNA
TX
01
—
HH9647
BLUE CROSS
TX
Enumeration date
05/23/2005
Last updated
08/02/2023
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