Basic Information
| Provider Information | |||||||||
| NPI: | 1386965630 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGITRACE CARE SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE PL | ||||||||
| Address2: | 5B | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019603840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 W CUMMINGS PARK | ||||||||
| Address2: | 5325 | ||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818489111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | NAUFUL | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP COMPLIANCE & CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 7703092000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 327004 | 01 | MA | BCBS MA | OTHER | 000063102 | 01 | MA | MEDICARE | OTHER |