Provider Demographics
NPI:1093745747
Name:DIGITRACE CARE SERVICES, INC
Entity Type:Organization
Organization Name:DIGITRACE CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP,CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:IBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-536-7400
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:978-535-9757
Practice Address - Street 1:2060 N VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2561
Practice Address - Country:US
Practice Address - Phone:254-741-0455
Practice Address - Fax:254-741-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126657901Medicaid
TX103364101OtherFIRST CARE
TXPL7236OtherBLUE CROSS
7618325OtherAETNA
TX0085DCOtherBLUE CROSS
TXPL7237OtherBLUE CROSS
TXPL7236OtherBLUE CROSS
TXPL7236OtherBLUE CROSS