Basic Information
| Provider Information | |||||||||
| NPI: | 1942233036 | ||||||||
| 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: | 8505 ARLINGTON BLVD | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033830156 | ||||||||
| FaxNumber: | 7033830158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | IBERGER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP,CFO | ||||||||
| AuthorizedOfficialTelephone: | 9785367400 | ||||||||
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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 | 252927 | 01 | VA | MAMSI | OTHER | 252927 | 01 | VA | ALLIANCE | OTHER | 7618325 | 01 | VA | AETNA | OTHER | 102822 | 01 | VA | KAISER | OTHER | 202073 | 01 | VA | ANTHEM BCBS - PIN | OTHER | 520537 | 01 | MD | CARE FIRST | OTHER | 659561 | 01 | VA | SOUTHERN HEALTH | OTHER | 252927 | 01 | VA | OPTIMUM | OTHER | 252927 | 01 | VA | MDIPA | OTHER | 2860005 | 01 | VA | AETNA | OTHER | 002284081 | 05 | VA | MEDICAID | 419630 | 01 | MD | CARE FIRST | OTHER | 85970002 | 01 | VA | CARE FIRST | OTHER | 85TZDI | 01 | MD | CARE FIRST | OTHER | 8011510 | 01 | VA | CIGNA | OTHER | 85970001 | 01 | VA | CARE FIRST | OTHER | MT35 | 01 | VA | BCBS | OTHER |