Basic Information
| Provider Information | |||||||||
| NPI: | 1497797096 | ||||||||
| 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: | 1010 GAR HWY | ||||||||
| Address2: | 1ST FLOOR UNIT 2 | ||||||||
| City: | SWANSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027774566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174729821 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | IBERGER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO-EVP | ||||||||
| AuthorizedOfficialTelephone: | 9785367400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 0274 | 01 | MA | NEIGHBORHOOD HEALTH RI | OTHER | 6178 | 01 | MA | FALLON | OTHER | 2860005 | 01 | MA | AETNA HMO | OTHER | 7618325 | 01 | MA | AETNA PPO | OTHER | 3400027 | 01 | MA | UNITED HEALTHCARE | OTHER | 607536 | 01 | MA | TUFTS | OTHER | 409503 | 01 | MA | BLUECHIP | OTHER | 9468 | 01 | MA | NEIGHBORHOOD HEALTH MA | OTHER | 626067 | 01 | MA | HARVARD PILGRIM | OTHER |