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NPI Code Detail

MEDICARE: JOHNNY SHANE ROSS INC

MEDICARE: JOHNNY SHANE ROSS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation PhysicianJ6036TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1613355600OTHEROKDEPARTMENT OF LABOR
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578694139
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHNNY SHANE ROSS INC
Provider Business Mailing Address
First Line : 2101 HEADWATER LN
Second Line :
City : AUSTIN
State : TX
Zip : 78746-7858
Country : US
Telephone Number : 580-585-0180
Fax Number :
Provider Business Practice Location Address
First Line : 2000 MEDICAL DR
Second Line :
City : LAKEWAY
State : TX
Zip : 78734-4200
Country : US
Telephone Number : 512-263-4511
Fax Number : 512-263-4506
Authorized Official
Title or Position : CORPORATE SECRETARY
Name : GINGER R ROSS
Credential :
Telephone Number : 580-585-0180
Provider Enumeration Date : 03/08/2007
Last Update Date : 02/25/2016

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Directions to “JOHNNY SHANE ROSS INC ” Practice Location

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