SHANNON MEDICAL CENTER (NPI# 1114987963) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114987963 |
| Entity Type | Organization |
| Organization Name | SHANNON MEDICAL CENTER |
| Practice Address |
2018 Pulliam St San Angelo TX 76905-5148 |
| Mailing Address |
Po Box 1879 San Angelo TX 76902-1879 |
| Practice Telephone | 3256575031 |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2011-08-26 |
| Authorized Official Name | MISS PATRICIA KIRKHAM (BILLING SUPERVISOR) |
| Authorized Official Telephone | 3256575031 |
| Is Organization Subpart | Y |
| Parent Organization Name | SHANNON MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 000916102 | 05 | |
| TX | BLUE CROSS SNF | HH2625 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730211533 | Shannon Medical Center | Ambulance | 120 E Harris, San Angelo, TX 76903 | 2007-03-09 |
| 1225031446 | Shannon Medical Center | Home Health | 2030 Pulliam St, Ste 6, San Angelo, TX 76905-5157 | 2005-05-23 |
| 1699016337 | Shannon Medical Center | Clinic/Center | 2008 Nine Rd, Brady, TX 76825-7210 | 2013-03-05 |
| 1336386028 | Shannon Medical Center | Clinic/Center | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2009-01-16 |
| 1013977784 | Shannon Medical Center | Psychiatric Hospital | 120 E Harris Ave, San Angelo, TX 76903-5904 | 2006-03-25 |
| 1992765663 | Shannon Medical Center | Chronic Disease Hospital | 120 E Harris Ave, San Angelo, TX 76903-5904 | 2006-03-25 |
| 1235199084 | Shannon Medical Center | Psychiatric Unit | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2006-03-24 |
| 1306806153 | Shannon Medical Center | Rehabilitation Unit | 120 E Harris Ave, San Angelo, TX 76903-5904 | 2006-03-24 |
| 1104886969 | Shannon Medical Center | Clinic/Center | 120 E Harris Ave, San Angelo, TX 76903-5904 | 2006-03-24 |
| 1992707228 | Shannon Medical Center | General Acute Care Hospital | 120 E Harris Ave, San Angelo, TX 76903-5904 | 2005-05-31 |
| Street Address |
2018 PULLIAM ST |
| City | SAN ANGELO |
| State | TX |
| Zip Code | 76905-5148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588646392 | Shannon Joint Ventures, Inc | Internal Medicine | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2005-11-17 |
| 1508369034 | Greg W Anderson | Nurse Practitioner | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2018-03-12 |
| 1881118693 | Fresenius Kidney Care Concho Valley, LLC | Clinic/Center | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2017-08-02 |
| 1336386028 | Shannon Medical Center | Clinic/Center | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2009-01-16 |
| 1184815342 | Susan C Wilkinson | Clinical Nurse Specialist | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2007-08-05 |
| 1003951245 | David Nichols | Emergency Medicine | 2018 Pulliam St, San Angelo, TX 76905 | 2007-02-21 |
| 1457368367 | Glen Michael Mcferren | Psychiatry & Neurology | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2006-08-02 |
| 1447279351 | Rangarao Chilukuri | Internal Medicine | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2006-07-19 |
| 1710913280 | Jackson Todd Achilles | Psychiatry & Neurology | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2006-06-24 |
| 1235199084 | Shannon Medical Center | Psychiatric Unit | 2018 Pulliam St, San Angelo, TX 76905-5148 | 2006-03-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639437197 | Richard Yeaton Burnell | Registered Nurse | 2018 Bus Us Highway 67-j, San Angelo, TX 76905 | 2012-05-02 |
| 1568752053 | Lucy Jo Smith | Counselor | 2710 Smith Blvd., San Angelo, TX 76905 | 2011-04-18 |
| 1821204587 | D&s Residential Services | Intermediate Care Facility, Mentally Retarded | 2706 Watson Street, San Angelo, TX 76905 | 2007-05-16 |
| 1770688103 | Alan Keith Carson | Counselor | 218 Pulliam St., San Angelo, TX 76905 | 2006-09-13 |
| 1851992515 | Stacie A Gregg | Nurse Practitioner | 1229 Johnny Ln, San Angelo, TX 76905-2331 | 2020-11-07 |
| 1417340910 | Leslie Ann Rendon | Contractor | 1213 Rita Cir, San Angelo, TX 76905-4201 | 2015-03-09 |
| 1972925295 | Carlos Robledo | Pharmacist | 2626 Smith Blvd, San Angelo, TX 76905-4285 | 2014-01-07 |
| 1376163501 | Megan Elizabeth Barnum | Registered Nurse | 1231 Rita Cir, San Angelo, TX 76905-4292 | 2020-04-17 |
| 1225031446 | Shannon Medical Center | Home Health | 2030 Pulliam St, Ste 6, San Angelo, TX 76905-5157 | 2005-05-23 |
| 1285845214 | Shannon Health Sys Pharmacy Pap | Pharmacy | 2030 Pulliam St Ste 16, San Angelo, TX 76905-5170 | 2007-05-24 |
| Find all providers in zip 76905 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336577873 | Meadow Creek Scc LLC | Skilled Nursing Facility | 4343 Oak Grove Blvd., San Angelo, TX 76904-4500 | 2013-10-18 |
| 1972663813 | Pm Management-san Angelo Nc I LLC | Skilled Nursing Facility | 4343 Oak Grove Blvd, San Angelo, TX 76904-4550 | 2006-12-11 |
| 1104986041 | Pm Management-san Angelo Nc II LLC | Skilled Nursing Facility | 3745 Summer Crest Dr, San Angelo, TX 76901-9782 | 2006-12-11 |
| 1720003536 | Legend Oaks - San Angelo, LLC | Skilled Nursing Facility | 5455 Knickerbocker Rd, San Angelo, TX 76904-7711 | 2006-07-13 |
| 1306875281 | Seminole Hospital District | Skilled Nursing Facility | 902 North Main Street, San Angelo, TX 76903-4077 | 2006-07-02 |
| 1588643761 | Cedar Manor Nursing & Rehab Center, LLC | Skilled Nursing Facility | 1915 Greenwood St, San Angelo, TX 76901-1112 | 2006-01-16 |
| 1215925920 | Stratford Hospital District | Skilled Nursing Facility | 609 Rio Concho Dr, San Angelo, TX 76903-6029 | 2005-10-07 |
| 1720623622 | Stratford Hospital District | Skilled Nursing Facility | 4343 Oak Grove Blvd., San Angelo, TX 76904 | 2019-11-14 |
| 1811532401 | Stratford Hospital District | Skilled Nursing Facility | 3745 Summer Crest Dr, San Angelo, TX 76901-9782 | 2019-11-07 |
| 1770042384 | Regency Ihs of San Angelo LLC San Angelo Nursing and Rehab | Skilled Nursing Facility | 5455 Knickerbocker Rd, San Angelo, TX 76904-7711 | 2019-03-14 |
| Find all providers in SAN ANGELO | ||||
| City | SAN ANGELO |
| Zip Code | 76905 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.