Organization
SHANNON CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO VILLARREAL (CAO)
(325) 481-8248
Entity
Organization
Contact information
Practice address
102 NORTH AVENUE H, OZONA, TX 76943-0907
(325) 392-3788
(325) 392-5445
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
(325) 481-2166
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149090601
—
TX
Enumeration date
07/29/2005
Last updated
02/27/2020
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