Look up the most recent NPI and PECOS records

Vickie R. Shannon

Internal Medicine

Allopathic & Osteopathic Physicians

1515 Holcombe Blvd, Houston, TX 77030-4009

PECOS Enrollment

This provider is enrolled in PECOS as VICKIE SHANNON.

Based on the most recent information from CMS, provider Vickie R. Shannon is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 8:41 AM.

Profile Details

Provider ID
1013003151
Provider Type
Individual
Full Name
Shannon, Vickie R.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
10/5/2006
Last Updated
6/29/2012

Contact Information

Practice Location

1515 Holcombe Blvd, Houston, TX 77030-4009

(713) 792-6161

Unlisted Fax

Mailing Location

PO Box 4439, Houston, TX 77210-4439

(713) 792-2991

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207RP1001X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License G7762 Texas

Provider Identifiers

ID	Description	Issuer
ID 103260901	Description Medicaid	Issuer Unlisted Texas
ID 82M149	Description Other	Issuer BCBS Texas
ID 110064818	Description Other	Issuer RR MEDICARE Texas

Vickie R. Shannon

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Bloom, Manuel G

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Hassan, Iman

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Hayat Syed, Muhammad Khyzar

Wilgus, May Lin

Zahiruddin, Faisal Nomaan

Sasieta, Humberto Carlos