SHANNON CLINIC REFERENCE LAB
NPI 1114119385
Clinical Medical Laboratory in San Angelo, TX

Active since August 13, 2007CLIA Certified · 3 labs
120 E BEAUREGARD AVE, SAN ANGELO, TX 76903(325) 658-1511 Get Directions Write a Review

NPPES record last updated: January 21, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 21, 2020, Mar 12, 2019 (2 updates tracked since 2019).

About Shannon Clinic Reference Lab NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANNON CLINIC REFERENCE LAB (NPI 1114119385) is a healthcare organization registered as a clinical medical laboratory in San Angelo, Texas and active in the NPI registry since August 2007. The organization holds 3 active CLIA laboratory certificates and lists Ricardo Villarreal, Cao, as its authorized official.

NPPES Registry Identity

NPI1114119385
Entity TypeOrganization
Primary Taxonomy291U00000X
Legal Business NameSHANNON CLINIC REFERENCE LAB
Location Address120 E BEAUREGARD AVESan Angelo, TX 76903-5919
Mailing AddressPo Box 22000San Angelo, TX 76902-7200 · (325) 658-1511
Organization SubpartNo
Authorized OfficialRicardo VillarrealCao · (325) 481-8248
Enumeration DateAugust 13, 2007
Last NPPES UpdateJanuary 21, 20202 updates tracked since enumeration
NPI 1114119385 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinical Medical LaboratoryLaboratories
Taxonomy Code291U00000X
Definition
(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.
120 E BEAUREGARD AVE, San Angelo, TX 76903

Other Identifiers 1

Medicaid127005001TX

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 45D0674425

Shannon Clinic Laboratory · San Angelo, TX
Active · expires Feb 14, 2028
CLIA Number45D0674425
Laboratory TypePhysician Office
Certificate Effective DateFebruary 15, 2026
Certificate Expiration DateFebruary 14, 2028
Laboratory DirectorDr. Anthony Soldano
Laboratory Phone(325) 481-2050
Laboratory LocationShannon Clinic Laboratory120 East Beauregard Ave, San Angelo, TX 76903
CLIA data matches this NPI record on: Address
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 45D1028341

Shannon Clinic · San Angelo, TX
Active · expires Jul 21, 2028
CLIA Number45D1028341
Laboratory TypePhysician Office
Certificate Effective DateJuly 22, 2026
Certificate Expiration DateJuly 21, 2028
Laboratory DirectorBrett Nile
Laboratory Phone(325) 245-4022
Laboratory LocationShannon Clinic2142 Sunset Drive, San Angelo, TX 76904
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 45D1046968

Shannon Clinic · San Angelo, TX
Active · expires Oct 23, 2027
CLIA Number45D1046968
Laboratory TypePhysician Office
Certificate Effective DateOctober 24, 2025
Certificate Expiration DateOctober 23, 2027
Laboratory DirectorHector F. Acton
Laboratory Phone(325) 245-4301
Laboratory LocationShannon Clinic2141 Hamilton Way #100, San Angelo, TX 76904
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Family Medicine
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Dermatology
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Internal Medicine
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Podiatrist
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Physician Assistant
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Physician Assistant
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903
Student in an Organized Health Care Education/Training Program
120 E BEAUREGARD AVE
SAN ANGELO, TX 76903

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shannon Clinic Reference Lab's NPI number?

The NPI number for Shannon Clinic Reference Lab is 1114119385. It was assigned to this organization in the NPPES registry on August 13, 2007.

Where is Shannon Clinic Reference Lab located?

Shannon Clinic Reference Lab is located at 120 E Beauregard Ave, San Angelo, TX 76903. The listed phone number is (325) 658-1511.

What is Shannon Clinic Reference Lab's specialty?

The primary specialty registered for this NPI is Clinical Medical Laboratory with taxonomy code 291U00000X.

Does Shannon Clinic Reference Lab hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Shannon Clinic Reference Lab was last updated on January 21, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.