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Organization
SHANNON CLINIC
Active
Organization
SHANNON CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO VILLARREAL (COO)
(325) 747-2200
Entity
Organization
Contact information
Practice address
120 E BEAUREGARD AVE, SAN ANGELO, TX 76903-5919
(325) 658-1511
(325) 481-2166
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
TX
207KA0200X
Allergy Physician
—
TX
207L00000X
Anesthesiology Physician
—
TX
207N00000X
Dermatology Physician
—
TX
207Q00000X
Family Medicine Physician
Primary
—
TX
207R00000X
Internal Medicine Physician
—
TX
207T00000X
Neurological Surgery Physician
—
TX
207V00000X
Obstetrics & Gynecology Physician
—
TX
207W00000X
Ophthalmology Physician
—
TX
207X00000X
Orthopaedic Surgery Physician
—
TX
207Y00000X
Otolaryngology Physician
—
TX
207ZB0001X
Blood Banking & Transfusion Medicine Physician
—
TX
208000000X
Pediatrics Physician
—
TX
2085R0202X
Diagnostic Radiology Physician
—
TX
208600000X
Surgery Physician
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T83Z
MEDICARE
TX
05
—
127005001
—
TX
01
—
127005002
CSHCN
TX
01
—
CL8387
MEDICARE PTAN
TX
Enumeration date
06/13/2005
Last updated
07/14/2025
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