SHANNON CLINIC
NPI 1770587149
Family Medicine in San Angelo, TX

Q: What is Shannon Clinic's NPI number?

The NPI number for Shannon Clinic is 1770587149. It was assigned to this organization in the NPPES registry on June 13, 2005.

Q: What is Shannon Clinic's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Shannon Clinic was last updated on July 14, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 13, 2005CLIA Certified · 5 labs

120 E BEAUREGARD AVE, SAN ANGELO, TX 76903(325) 658-1511(325) 481-2166 Get Directions Write a Review

NPPES record last updated: July 14, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 21, 2022, Jul 15, 2022, Dec 14, 2021 and 3 more (6 updates tracked since 2019).

On this page

About Shannon Clinic NPPES

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

SHANNON CLINIC (NPI 1770587149) is a healthcare organization registered as a family medicine in San Angelo, Texas and active in the NPI registry since June 2005. The organization holds 5 active CLIA laboratory certificates and lists Ricardo Villarreal, Coo, as its authorized official.

NPPES Registry Identity

NPI1770587149

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameSHANNON CLINIC

Location Address120 E BEAUREGARD AVESan Angelo, TX 76903-5919

Mailing AddressPo Box 22000San Angelo, TX 76902-7200 · (325) 658-1511

Phone(325) 658-1511

Fax(325) 481-2166

Organization SubpartNo

Authorized OfficialRicardo VillarrealCoo · (325) 747-2200

Enumeration DateJune 13, 2005

Last NPPES UpdateJuly 14, 20256 updates tracked since enumeration

NPPES CertifiedJuly 14, 2025

✔ NPI 1770587149 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

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.

Also ListedAllergy & ImmunologyTaxonomy 207K00000X

Also ListedAllergy & Immunology · AllergyTaxonomy 207KA0200X

Also ListedAnesthesiologyTaxonomy 207L00000X

Also ListedDermatologyTaxonomy 207N00000X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedNeurological SurgeryTaxonomy 207T00000X

Also ListedObstetrics & GynecologyTaxonomy 207V00000X

Also ListedOphthalmologyTaxonomy 207W00000X

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X

Also ListedOtolaryngologyTaxonomy 207Y00000X

Also ListedPathology · Blood Banking & Transfusion MedicineTaxonomy 207ZB0001X

Also ListedPediatricsTaxonomy 208000000X

Also ListedRadiology · Diagnostic RadiologyTaxonomy 2085R0202X

Also ListedSurgeryTaxonomy 208600000X

120 E BEAUREGARD AVE, San Angelo, TX 76903

Open in Google Maps ↗

Other Identifiers 4

Other00T83ZTX · Medicare

Other127005002TX · Cshcn

OtherCL8387TX · Medicare Ptan

Medicaid127005001TX

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 5

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 for Provider-Performed Microscopy Procedures (PPMP) 45D2150292

Shannon Clinic Jackson · San Angelo, TX

Active · expires Jun 20, 2028

CLIA Number45D2150292

Laboratory TypePhysician Office

Certificate Effective DateJune 21, 2026

Certificate Expiration DateJune 20, 2028

Laboratory DirectorAnderew P. King

Laboratory Phone(325) 658-1551

Laboratory LocationShannon Clinic Jackson2237 S Jackson, San Angelo, TX 76904

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Waiver 45D2113538

Shannon Clinic Southwest · San Angelo, TX

Active · expires May 23, 2028

CLIA Number45D2113538

Laboratory TypePhysician Office

Certificate Effective DateMay 24, 2026

Certificate Expiration DateMay 23, 2028

Laboratory DirectorDavid M. Huchton

Laboratory Phone(325) 481-2050

Laboratory LocationShannon Clinic Southwest4450 Sunset Dr, 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 45D2113541

Shannon Clinic-Mobile Care Unit · San Angelo, TX

Active · expires May 23, 2028

CLIA Number45D2113541

Laboratory TypePhysician Office

Certificate Effective DateMay 24, 2026

Certificate Expiration DateMay 23, 2028

Laboratory DirectorRobert D. Schultz

Laboratory Phone(325) 481-2050

Laboratory LocationShannon Clinic-Mobile Care Unit2018 Pulliam, San Angelo, TX 76905

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 45D2043072

Shannon Clinic South 3 · San Angelo, TX

Active · expires Sep 7, 2027

CLIA Number45D2043072

Laboratory TypePhysician Office

Certificate Effective DateSeptember 8, 2025

Certificate Expiration DateSeptember 7, 2027

Laboratory DirectorAnthony C. Soldano

Laboratory Phone(325) 245-4003

Laboratory LocationShannon Clinic South 33350 Executive Drive, San Angelo, TX 76904

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 45D2221579

Shannon Clinic Knickerbocker · San Angelo, TX

Active · expires Apr 21, 2027

CLIA Number45D2221579

Laboratory TypePhysician Office

Certificate Effective DateApril 22, 2025

Certificate Expiration DateApril 21, 2027

Laboratory DirectorJoe A. Mims

Laboratory Phone(325) 481-2050

Laboratory LocationShannon Clinic Knickerbocker3555 Knickerbocker Rd Suite 202, San Angelo, TX 76904

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS 31

Medicare supplier enrollment and the product categories Shannon Clinic carries, from the Medicare DMEPOS supplier directory.

Shannon Clinic

DMEPOS supplier · San Angelo, TX

✔

Accepts Medicare assignment

Shannon Clinic agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20668205

Medicare Participant SinceSeptember 1, 1995

Supplier Location120 E Beauregard AveSan Angelo, TX 76903

Phone(325) 947-6512

Provider TypeIndependently-Practicing Physical Therapist · Multi-Specialty - Physician

Supplier Specialties

Orthotic Personnel

Medicare Product Categories

Epoetin

Epoetin is a man-made version of human erythropoietin (EPO)

Immunosuppressive Drugs

Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant

Infusion Drugs

Nebulizer Drugs

Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect

Oral Anticancer Drugs

FDA anticancer drugs

Oral Antiemetic Drugs

FDA antiemetic drugs

Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Leave this field empty

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.

MAEGIN M CARLILE FNP

Nurse Practitioner