SHANNON CLINIC REFERENCE LAB (NPI# 1114119385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114119385 |
| Entity Type | Organization |
| Organization Name | SHANNON CLINIC REFERENCE LAB |
| Practice Address |
120 E Beauregard Ave San Angelo TX 76903-5919 |
| Mailing Address |
Po Box 22000 San Angelo TX 76902-7200 |
| Practice Telephone | 3256581511 |
| Mailing Telephone | 3256581511 |
| Enumeration Date | 2007-08-13 |
| 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 | 291U00000X | Clinical Medical Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 127005001 | 05 |
| Street Address |
120 E BEAUREGARD AVE |
| City | SAN ANGELO |
| State | TX |
| Zip Code | 76903-5919 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114921459 | Ernest Charlesworth | Dermatology | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2005-06-01 |
| 1093349359 | Michael T Mcenrue | Nurse Practitioner | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2020-02-26 |
| 1194298596 | Rachel J Reyes | Nurse Practitioner | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2019-01-08 |
| 1649746512 | Jessica Orona | Nurse Practitioner | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2018-10-18 |
| 1770960312 | Dawn Empey | Registered Nurse | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2015-05-04 |
| 1639573231 | Eduardo Jose Gonzalez | Internal Medicine | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2014-10-10 |
| 1043626518 | Emily Michelle Dodd | Anesthesiology | 120 E Beauregard Ave, San Angelo, TX 76903 | 2014-07-06 |
| 1487080479 | Melissa P Hohensee | Nurse Practitioner | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2013-09-23 |
| 1003168055 | Maegin M Carlile | Nurse Practitioner | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2012-10-15 |
| 1760746325 | Kristi D. Urias | Anesthesiology | 120 E Beauregard Ave, San Angelo, TX 76903-5919 | 2012-06-28 |
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| 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 |
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| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (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. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174043962 | H-e-b, Lp | Clinical Medical Laboratory | 5502 Sherwood Way, San Angelo, TX 76901 | 2017-06-22 |
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| City | SAN ANGELO |
| Zip Code | 76903 |
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| 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.