MEDICARE: DR. JAMES EDWARD ROTH MD

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
1	207QS1201X	Sleep Medicine (Family Medicine) Physician	MD17117	TN
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD17117	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4130055	OTHER	TN	BLUECROSS BLUESHEILD TN
2	5358058	OTHER	TN	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437105608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARD ROTH MD

Provider Business Mailing Address
First Line	:	801 HUNTINGTON CIR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6112
Country	:	US
Telephone Number	:	615-943-9294
Fax Number	:	931-723-7815

Provider Business Practice Location Address
First Line	:	1600 MCARTHUR ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2522
Country	:	US
Telephone Number	:	931-723-7950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	03/07/2023

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