| N H Shannon Md Pa | |
|
3326 E Southcross Blvd San Antonio TX 78223-1922 | |
| (210) 532-3216 | |
| (210) 532-6055 |
| Full Name | N H Shannon Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 3326 E Southcross Blvd, San Antonio, Texas |
| Authorized Official Name and Position | Nick H Shannon (PRESIDENT) |
| Authorized Official Contact | 2105324555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N H Shannon Md Pa 3326 E Southcross Blvd San Antonio TX 78223-1922 Ph: (210) 532-3216 | N H Shannon Md Pa 3326 E Southcross Blvd San Antonio TX 78223-1922 Ph: (210) 532-3216 |
| NPI Number | 1386946903 |
|---|---|
| Provider Enumeration Date | 12/02/2010 |
| Last Update Date | 12/02/2010 |
| Medicare PECOS PAC ID | 7113101726 |
|---|---|
| Medicare Enrollment ID | O20110406000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386946903 | NPI | - | NPPES |
| 092125601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D2834 (Texas) | Primary |
| 207QG0300X | Family Medicine - Geriatric Medicine | D2834 (Texas) | Secondary |
| 208D00000X | General Practice | D2834 (Texas) | Secondary |
| Provider Name | Nick H Shannon |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1619076114 PECOS PAC ID: 7719161322 Enrollment ID: I20110406000253 |
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