Provider Demographics
NPI:1710007885
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:R
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:978-536-7400
Mailing Address - Fax:
Practice Address - Street 1:60 CHASTAIN CENTER BLVD NW
Practice Address - Street 2:SUITE 66
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5598
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:2007-03-30
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