SHANNON CLINIC (NPI# 1790986719) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790986719 |
| Entity Type | Organization |
| Organization Name | SHANNON CLINIC |
| Other Organization Name | VISTA VERDE MEDICAL PLAZA |
| Practice Address |
1801 N Bedell Ave Del Rio TX 78840-8001 |
| Mailing Address |
Po Box 90201 San Angelo TX 76902-8001 |
| Practice Telephone | 8307689200 |
| Mailing Telephone | 3256581511 |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GARY BOWEN (CHIEF OPERATIONS OFFICER) |
| Authorized Official Telephone | 3256581511 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| X | 208000000X | Pediatrics | TX | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| VISTA VERDE MEDICAL PLAZA | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245230465 | Shannon Clinic | Clinic/Center | 102 North Avenue H, Ozona, TX 76943-0907 | 2005-07-29 |
| 1356752307 | Shannon Clinic | Prosthetic/Orthotic Supplier | 110 E Twohig Ave, San Angelo, TX 76903-5916 | 2014-05-13 |
| 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 |
| 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 |
| New York State Corporations | SHANNON CLINICAL CONSULTING LLC | 315 7th Avenue, #20b, New York, Ny 100016011 |
| Street Address |
1801 N BEDELL AVE |
| City | DEL RIO |
| State | TX |
| Zip Code | 78840-8001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790775435 | Lawrence A. O'brien | Pediatrics | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2005-10-25 |
| 1013552637 | Carrie Leigh Kern | Nurse Practitioner | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2019-11-07 |
| 1093245771 | Leticia Ortiz | Nurse Practitioner | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2017-06-15 |
| 1912390253 | Caitlin C. Oetken | Physician Assistant | 1801 N Bedell Ave, Del Rio, TX 78840 | 2015-03-11 |
| 1891124640 | Val Verde Hospital Corporation | Family Medicine | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2013-11-02 |
| 1699118307 | Jose Americo Mendoza | Family Medicine | 1801 N Bedell Ave, Del Rio, TX 78840 | 2013-04-11 |
| 1437401973 | Sasha Nicole Valdez | Registered Nurse | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2012-10-08 |
| 1518258433 | Elisicia Louise Taylor Jiles | Family Medicine | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2011-04-26 |
| 1578753729 | Jorge Eduardo Olaya | Pediatrics | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2007-07-25 |
| 1689711228 | Jerri Hoehn | Clinical Nurse Specialist | 1801 N Bedell Ave, Del Rio, TX 78840-4491 | 2007-01-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104363431 | Irma Chapa | Pharmacist | 200 Vetrans Blvd, Del Rio, TX 78840 | 2017-01-25 |
| 1538605621 | Maternity Care Center | Advanced Practice Midwife | 1308 Las Vacas St, Del Rio, TX 78840 | 2017-01-12 |
| 1215323514 | Kathleen Schurr | Military Health Care Provider | 47th Medical Group, Laughlin Afb, TX 78840 | 2015-04-13 |
| 1902232259 | Ruben E Mora | Dentist | 551 W Cantu Rd., Del Rio, TX 78840 | 2013-09-18 |
| 1326489758 | Javier Rodriguez-sanchez | Internal Medicine | 2201 N Bedell Ave Ste E, Del Rio, TX 78840 | 2013-07-15 |
| 1205111267 | Raymond Keith Blottin | Counselor | 114 West Losoya, Serenity Counseling, Del Rio, TX 78840 | 2011-10-20 |
| 1194011072 | Nicole Alexcine Deboer | Physician Assistant | 913 S. Main St., United Medical Centers, Del Rio, TX 78840 | 2011-06-20 |
| 1205125713 | Del Rio Ambulance LLC | Ambulance | 126 W. Ogden St., Del Rio, TX 78840 | 2011-04-05 |
| 1285880476 | Luis Carlos Salinas | Obstetrics & Gynecology | 3614 Cocobolo Street, Del Rio, TX 78840 | 2008-08-07 |
| 1417158239 | Heart Specialists of Texas Pa | Internal Medicine | 1109 Ave K, Del Rio, TX 78840 | 2007-05-30 |
| Find all providers in zip 78840 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295850865 | Angel Martinez M.d. Family Practice Clinic Pa | Family Medicine | 712 N Bedell Ave, Del Rio, TX 78840-4111 | 2007-03-20 |
| 1912069907 | Gutierrez Medical Center | Family Medicine | 612 Bedell Ave, Suite D, Del Rio, TX 78840 | 2006-12-15 |
| 1962404004 | Antonio Cadena | Family Medicine | 2201 N Bedell Ave Ste A, Del Rio, TX 78840-8021 | 2005-06-01 |
| 1730738097 | Southwest Medical Ventures Pllc | Family Medicine | 612 N Bedell Ave Ste A, Del Rio, TX 78840-4173 | 2019-09-10 |
| 1891124640 | Val Verde Hospital Corporation | Family Medicine | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2013-11-02 |
| 1699118307 | Jose Americo Mendoza | Family Medicine | 1801 N Bedell Ave, Del Rio, TX 78840 | 2013-04-11 |
| 1225302102 | Gutierrez Md Pllc | Family Medicine | 612 N Bedell Ave, Ste A, Del Rio, TX 78840-4173 | 2012-02-24 |
| 1518258433 | Elisicia Louise Taylor Jiles | Family Medicine | 1801 N Bedell Ave, Del Rio, TX 78840-8001 | 2011-04-26 |
| 1356509004 | Mohan Ravindra Gadam | Family Medicine | 801 N Bedell Ave, Del Rio, TX 78840-4112 | 2008-05-29 |
| 1649437559 | Cadena Family Practice | Family Medicine | 2201 N Bedell Ave, Suite A, Del Rio, TX 78840-8020 | 2008-05-19 |
| Find all providers in DEL RIO | ||||
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.