Organization
SHANNON MEDICAL CENTER
Active
Parent organization
SHANNON MEDICAL CENTER
Other names
Shannon Medical Center - Outpatient Dialysis Facility
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHANNON MEDICAL CENTER
Authorized official
MISS PATRICIA KIRKHAM (BILLING SUPERVISOR)
(325) 657-5031
Entity
Organization
Contact information
Practice address
2018 PULLIAM ST, SAN ANGELO, TX 76905-5148
(325) 653-6741
Mailing address
PO BOX 1879, SAN ANGELO, TX 76902-1879
(325) 653-6741
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
00168
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148371103
—
TX
Enumeration date
01/16/2009
Last updated
08/26/2011
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