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Organization

SHANNON CLINIC REFERENCE LAB

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RICARDO VILLARREAL (CAO)
(325) 481-8248
Entity
Organization

Contact information

Practice address
120 E BEAUREGARD AVE, SAN ANGELO, TX 76903-5919
(325) 658-1511
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
127005001
TX
Enumeration date
08/13/2007
Last updated
01/21/2020
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