# JOHNNY SHANE ROSS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Johnny Shane Ross, M.D.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578694139
- **Authorized official:** GINGER R ROSS (CORPORATE SECRETARY)
- **Authorized official phone:** (580) 585-0180

## Contact information

- **Practice address:** 2000 MEDICAL DR, LAKEWAY, TX 78734-4200
- **Practice address phone:** (512) 263-4511
- **Practice address fax:** (512) 263-4506
- **Mailing address:** 2101 HEADWATER LN, AUSTIN, TX 78746-7858
- **Mailing address phone:** (580) 585-0180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | J6036 | TX | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 02/25/2016