Provider Demographics
NPI:1245417963
Name:DIGITRACE CARE SERVICES
Entity Type:Organization
Organization Name:DIGITRACE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-536-7400
Mailing Address - Street 1:60 CHASTAIN CENTER BLVD NW
Mailing Address - Street 2:SUITE 66
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5598
Mailing Address - Country:US
Mailing Address - Phone:770-592-5544
Mailing Address - Fax:
Practice Address - Street 1:907 MAR WALT DR
Practice Address - Street 2:SUITE 2021
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6960
Practice Address - Country:US
Practice Address - Phone:850-863-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
7618325OtherAETNA