Provider Demographics
NPI:1598369357
Name:KRISTOPHER R SHANNON LLC
Entity Type:Organization
Organization Name:KRISTOPHER R SHANNON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-636-4864
Mailing Address - Street 1:CASTLEVIEW HOSPITAL, EMERGENCY DEPARTMENT
Mailing Address - Street 2:300 N HOSPITAL DR
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4218
Mailing Address - Country:US
Mailing Address - Phone:435-636-4864
Mailing Address - Fax:
Practice Address - Street 1:300 NORTH HOSPITAL DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-637-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty