Basic Information
| Provider Information | |||||||||
| NPI: | 1720099179 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIGITRACE CARE SERVICES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SLEEPMED | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 10 DORRANCE ST | ||||||||
| Address2: | SUITE 735 7TH FLOOR | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029032018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015193787 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 02/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | ROSE | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE & ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 9785367400 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 6178 | 01 | RI | FALLON | OTHER | 3400027 | 01 | RI | UNITED HEALTHCARE | OTHER | 409503 | 01 | RI | BLUE CHIP | OTHER | 607536 | 01 | RI | TUFTS | OTHER | SF038169 | 01 | RI | BCBS OF MA | OTHER | 0000022164 | 01 | RI | BC/BS OF RI | OTHER | 9513801 | 01 | AETNA | OTHER | 626067 | 01 | RI | HARVARD PILGRIM | OTHER | 0274 | 01 | RI | NEIGHBORHOOD HP RI | OTHER | 2860005 | 01 | RI | AETNA HMO | OTHER | 7618325 | 01 | RI | AETNA PPO | OTHER | 9468 | 01 | RI | NEIGHBORHOOD HP MA | OTHER |