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Organization
SHANNON RURAL HEALTH CLINICS, INC
Active
Organization
SHANNON RURAL HEALTH CLINICS, INC
Active
Other names
SENIOR CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
BOB KAVISIC (OFFICE MANAGER)
(325) 949-9408
Entity
Organization
Contact information
Practice address
3016 VISTA DEL ARROYO DR, SAN ANGELO, TX 76904-6146
(325) 949-9408
Mailing address
PO BOX 1879, SAN ANGELO, TX 76902-1879
(325) 949-9408
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G5439
TX
207QA0505X
Adult Medicine Physician
H4593
TX
Other
Enumeration date
08/07/2007
Last updated
08/07/2007
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