Organization
JOHNNY SHANE ROSS INC
Active
Other names
Johnny Shane Ross, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
GINGER R ROSS (CORPORATE SECRETARY)
(580) 585-0180
Entity
Organization
Contact information
Practice address
2000 MEDICAL DR, LAKEWAY, TX 78734-4200
(512) 263-4511
(512) 263-4506
Mailing address
2101 HEADWATER LN, AUSTIN, TX 78746-7858
(580) 585-0180
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J6036
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3445785 01
—
TX
01
—
613355600
DEPARTMENT OF LABOR
OK
Enumeration date
03/08/2007
Last updated
02/25/2016
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