1. Home
  2. Directory
  3. Texas
  4. San Angelo
  5. Family Medicine
  6. NPI Profile

SHANNON SENIOR HEALTH CLINIC
NPI 1194935569
Family Medicine - Adult Medicine in San Angelo, TX

Active since May 23, 2007CLIA 45D1047478 · Waiver
3016 VISTA DEL ARROYO DR, SAN ANGELO, TX 76904(325) 949-9408 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shannon Senior Health Clinic NPPES

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

SHANNON SENIOR HEALTH CLINIC (NPI 1194935569) is a healthcare organization registered as an adult medicine in San Angelo, Texas and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through November 6, 2027 and lists Irvin Zietler, Physician, as its authorized official.

NPPES Registry Identity

NPI1194935569
Entity TypeOrganization
Primary Taxonomy207QA0505X
Legal Business NameSHANNON SENIOR HEALTH CLINIC
Location Address3016 VISTA DEL ARROYO DRSan Angelo, TX 76904-6146
Mailing Address3016 Vista Del Arroyo DrSan Angelo, TX 76904-6146 · (325) 949-9408
Phone(325) 949-9408
Organization SubpartNo
Authorized OfficialIrvin ZietlerPhysician · (325) 949-9408
Enumeration DateMay 23, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1194935569 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
License✔ Licensed in TX · F4722
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
3016 VISTA DEL ARROYO DR, San Angelo, TX 76904
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

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 Waiver 45D1047478

Shannon Senior Health Center · San Angelo, TX
Active · expires Nov 6, 2027
CLIA Number45D1047478
Laboratory TypePhysician Office
Certificate Effective DateNovember 7, 2025
Certificate Expiration DateNovember 6, 2027
Laboratory DirectorGary A. Nussey
Laboratory Phone(325) 949-9408
Laboratory LocationShannon Senior Health Center3016 Vista Del Arroyo, San Angelo, TX 76904
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

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

DR. BRENDA D OWENS MD
Family Medicine
3016 VISTA DEL ARROYO DR
SAN ANGELO, TX 76904
Tom Green County (325) 658-1511
SHANNON RURAL HEALTH CLINICS, INC
Family Medicine
3016 VISTA DEL ARROYO DR
SAN ANGELO, TX 76904
Tom Green County (325) 949-9408
BRANDI L DEPALMA CNS
Clinical Nurse Specialist (Adult Health)
3016 VISTA DEL ARROYO DR
SAN ANGELO, TX 76904
Tom Green County (325) 949-9408
KRISTY D EDWARDS MD
Family Medicine
3016 VISTA DEL ARROYO DR
SAN ANGELO, TX 76904
Tom Green County (325) 658-1511

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 Senior Health Clinic's NPI number?

The NPI number for Shannon Senior Health Clinic is 1194935569. It was assigned to this organization in the NPPES registry on May 23, 2007.

Where is Shannon Senior Health Clinic located?

Shannon Senior Health Clinic is located at 3016 Vista Del Arroyo Dr, San Angelo, TX 76904. The listed phone number is (325) 949-9408.

What is Shannon Senior Health Clinic's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Does Shannon Senior Health Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D1047478) is associated with this NPI, valid through November 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shannon Senior Health Clinic was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.