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NPI Code Detail

MEDICARE: MICHAEL ROSS PA

MEDICARE: MICHAEL ROSS PA
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
1363A00000XPhysician AssistantPA04079TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396853396
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ROSS PA
Provider Business Mailing Address
First Line : PO BOX 22000
Second Line :
City : SAN ANGELO
State : TX
Zip : 76902-7200
Country : US
Telephone Number : 325-942-8611
Fax Number : 325-481-2165
Provider Business Practice Location Address
First Line : 3502 KNICKERBOCKER RD
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-7671
Country : US
Telephone Number : 325-942-8611
Fax Number : 325-659-0180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 06/25/2013

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Directions to “ MICHAEL ROSS PA” Practice Location

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