SHANNON CLINIC (NPI# 1356752307) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356752307 |
| Entity Type | Organization |
| Organization Name | SHANNON CLINIC |
| Practice Address |
110 E Twohig Ave San Angelo TX 76903-5916 |
| Mailing Address |
Po Box 22000 San Angelo TX 76902-7200 |
| Practice Telephone | 3256581511 |
| Practice Fax Number | 3254812166 |
| Mailing Telephone | 3256581511 |
| Mailing Fax Number | 3254812166 |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2020-01-21 |
| Authorized Official Name | RICARDO VILLARREAL (CAO) |
| Authorized Official Telephone | 3254818248 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | 1210 | TX | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | CERTIFICATION | CPED4075 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245230465 | Shannon Clinic | Clinic/Center | 102 North Avenue H, Ozona, TX 76943-0907 | 2005-07-29 |
| 1093051401 | Shannon Clinic | Clinic/Center | 201 E Arizona Ave, Sweetwater, TX 79556-7119 | 2012-12-13 |
| 1285946913 | Shannon Clinic | Durable Medical Equipment & Medical Supplies | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2010-07-10 |
| 1285954396 | Shannon Clinic | Prosthetic/Orthotic Supplier | 110 E Twohig Ave, San Angelo, TX 76903-5916 | 2010-06-11 |
| 1790986719 | Shannon Clinic | Family Medicine | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2007-05-29 |
| 1124038633 | Shannon Clinic | Durable Medical Equipment & Medical Supplies | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2006-08-08 |
| 1770587149 | Shannon Clinic | Allergy & Immunology | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2005-06-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SHANNON CLINIC | 120 E Beauregard Ave, San Angelo, TX 76903-5919 |
| Street Address |
110 E TWOHIG AVE |
| City | SAN ANGELO |
| State | TX |
| Zip Code | 76903-5916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477620185 | Janice M Morris | Orthotist | 110 E Twohig Ave, San Angelo, TX 76903-5916 | 2006-11-29 |
| 1174934186 | Kylan Wilson | Orthotist | 110 E Twohig Ave, San Angelo, TX 76903-5916 | 2014-05-13 |
| 1285954396 | Shannon Clinic | Prosthetic/Orthotic Supplier | 110 E Twohig Ave, San Angelo, TX 76903-5916 | 2010-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306386081 | The Waterford Wellness Spa | Clinic/Center | 602 S. Abe, San Angelo, TX 76903 | 2017-03-01 |
| 1154782415 | Jerrica Elayne Escobedo | Counselor | 424 South Oakes, San Angelo, TX 76903 | 2016-03-15 |
| 1578923868 | Wal-mart Stores Texas, LLC | Technician/Technologist | 3440 S. Bryant Blvd, San Angelo, TX 76903 | 2016-02-29 |
| 1821475161 | San Angelo Dental, Pllc | Dentist | 614 29th Street, Suite, Sanangelo, TX 76903 | 2015-05-06 |
| 1033549670 | Tina Faye Luck | Nurse Practitioner | 36 E Twohig Ave Ste 1100, San Angelo, TX 76903 | 2013-11-18 |
| 1295087294 | Tara Joiner | Counselor | 27 W Beauregard Ave, San Angelo, TX 76903 | 2012-10-15 |
| 1225380728 | Tanya L Favor | Physician Assistant | 215 E. College, San Angelo, TX 76903 | 2012-10-08 |
| 1336459551 | Education Service Center | Social Worker | 612 S Irene, San Angelo, TX 76903 | 2010-10-21 |
| 1508194176 | Pay and Save Inc | Pharmacy | 1926 N. Bryant Blvd., San Angelo, TX 76903 | 2009-11-19 |
| 1326375734 | Pay and Save Inc | Pharmacy | 2 S. Main St., San Angelo, TX 76903 | 2009-11-05 |
| Find all providers in zip 76903 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285954396 | Shannon Clinic | Prosthetic/Orthotic Supplier | 110 E Twohig Ave, San Angelo, TX 76903-5916 | 2010-06-11 |
| 1811165988 | Lamb's Contact Lenses & Artificial Eyes | Prosthetic/Orthotic Supplier | 515 W Beauregard Ave, San Angelo, TX 76903-6360 | 2008-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627997 | Tactical Rehabilitation Inc | Prosthetic/Orthotic Supplier | 2710 S. Clear Creek, Suite 110, Killeen, TX 76549-6685 | 2020-10-22 |
| 1962001123 | Tactical Rehabilitation Inc | Prosthetic/Orthotic Supplier | 2710 Clear Creek Rd Apt 110, Killeen, TX 76549-6685 | 2020-10-20 |
| 1871191643 | Cranial Technologies, Inc. | Prosthetic/Orthotic Supplier | 2020 W State Highway 114 Ste 360, Grapevine, TX 76051-8649 | 2020-10-14 |
| 1396351573 | Baker O & P Enterprises, Inc. | Prosthetic/Orthotic Supplier | 1104 West 34th St., Bldg. A, Austin, TX 78705-1910 | 2020-09-22 |
| 1184230815 | Lindas Signature Hair Studio Inc | Prosthetic/Orthotic Supplier | 9415 Broadway St Ste 201, Pearland, TX 77584-8094 | 2020-09-18 |
| 1538773106 | Memorial Prosthetics and Orthotics Inc | Prosthetic/Orthotic Supplier | 439 Mason Park Blvd Ste A1, Katy, TX 77450-4163 | 2020-09-01 |
| 1447861828 | Major Miracles Rx | Prosthetic/Orthotic Supplier | 1801 E 51st St Ste 362, Austin, TX 78723-3434 | 2020-08-11 |
| 1396355061 | Ameristep Prosthetics San Antonio | Prosthetic/Orthotic Supplier | 7271 Wurzbach Rd Ste 187, San Antonio, TX 78240-3800 | 2020-08-06 |
| 1043820327 | Ameristep Prosthetics Southwestern | Prosthetic/Orthotic Supplier | 5406 Harry Hines Blvd, Dallas, TX 75235-7211 | 2020-08-03 |
| 1083230502 | Amazing Wig Closet | Prosthetic/Orthotic Supplier | 409 W Front St Ste 100-306, Hutto, TX 78634-4204 | 2020-06-20 |
| Find all providers with the same taxonomy | ||||
| City | SAN ANGELO |
| Zip Code | 76903 |
Please comment or provide details below to improve the information on SHANNON CLINIC.
| 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.