Basic Information
| Provider Information | |||||||||
| NPI: | 1699953448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGITRACE CARE SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 CHASTAIN CENTER BLVD NW | ||||||||
| Address2: | SUITE 66 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301445598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705925544 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6820 RIDGE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441295646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408450022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2008 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | IBERGER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 9785367400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 7618325 | 01 | AETNA | OTHER |