Basic Information
| Provider Information | |||||||||
| NPI: | 1215211602 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGITRACE CARE SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SLEEPMED | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE PLACE | ||||||||
| Address2: | SUITE 5B | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019603840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
| FaxNumber: | 9785359778 | ||||||||
| Practice Location | |||||||||
| Address1: | 1185 N. CONCORD STREET | ||||||||
| Address2: | SUITE 411 | ||||||||
| City: | SOUTH ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550751187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514574293 | ||||||||
| FaxNumber: | 6514574910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2011 | ||||||||
| LastUpdateDate: | 04/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | IBERGER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP-CAO | ||||||||
| AuthorizedOfficialTelephone: | 9785367400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.