Basic Information
| Provider Information | |||||||||
| NPI: | 1538114277 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGITRACE CARE SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE PL | ||||||||
| Address2: | SUITE 5B | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019603840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
| FaxNumber: | 9785359757 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 CENTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012745716 | ||||||||
| FaxNumber: | 4012722646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | IBERGER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP CFO | ||||||||
| AuthorizedOfficialTelephone: | 9785366105 | ||||||||
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| 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 |
ID Information
| ID | Type | State | Issuer | Description | 22164 | 01 | RI | BCBS OF RI | OTHER | 409503 | 01 | RI | BLUE CHIP | OTHER | 6178 | 01 | RI | FALLON | OTHER | 0274 | 01 | RI | NHP RI | OTHER | 607536 | 01 | RI | TUFTS | OTHER | SF038169 | 01 | RI | BCBS OF MA | OTHER | 2860005 | 01 | RI | AETNA HMO | OTHER | 7618325 | 01 | RI | AETNA PPO | OTHER | 626067 | 01 | RI | HARVARD PILGRIM | OTHER | 3400027 | 01 | RI | UNITED HEALTHCARE | OTHER | 9468 | 01 | RI | NHP MA | OTHER |