| 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 |
|---|---|
| Provider Enumeration Date | 09/20/2010 |
| Last Update Date | 09/20/2010 |
| Medicare PECOS PAC ID | 4183740343 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710968383 PECOS PAC ID: 5890811061 Enrollment ID: I20100924000606 |
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