Philip A. Roth, Jr., Md/pc | |
2089 Cecil Ashburn Dr Se Suite 101 Huntsville AL 35802-2567 | |
(256) 533-3966 | |
(256) 533-9652 |
Full Name | Philip A. Roth, Jr., Md/pc |
---|---|
Speciality | Family Medicine |
Location | 2089 Cecil Ashburn Dr Se, Huntsville, Alabama |
Authorized Official Name and Position | Philip A. Roth (PRESIDENT) |
Authorized Official Contact | 2565333966 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Philip A. Roth, Jr., Md/pc 420 Lowell Dr Se Suite 103 Huntsville AL 35801-3754 Ph: (256) 535-5940 | Philip A. Roth, Jr., Md/pc 2089 Cecil Ashburn Dr Se Suite 101 Huntsville AL 35802-2567 Ph: (256) 533-3966 |
NPI Number | 1144538513 |
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Provider Enumeration Date | 09/20/2010 |
Last Update Date | 09/20/2010 |
Medicare PECOS PAC ID | 4183740343 |
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Medicare Enrollment ID | O20100924000433 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144538513 | NPI | - | NPPES |
0004036975 | Other | AL | AETNA |
080055438 | Other | AL | RAILROAD MEDICARE |
000085204 | Medicaid | AL | |
510-85204 | Other | AL | BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 12141 (Alabama) | Primary |
Provider Name | Philip A Roth |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710968383 PECOS PAC ID: 5890811061 Enrollment ID: I20100924000606 |
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