Provider Demographics
NPI:1598942989
Name:DIGITRACE CARE SERVICES
Entity Type:Organization
Organization Name:DIGITRACE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:IBERGER
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 1:11790 SW BARNES RD
Practice Address - Street 2:SUITE 330
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5934
Practice Address - Country:US
Practice Address - Phone:978-536-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
7618325OtherAETNA