Provider Demographics
NPI:1942233036
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 1:8505 ARLINGTON BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4621
Practice Address - Country:US
Practice Address - Phone:703-383-0156
Practice Address - Fax:703-383-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA252927OtherMAMSI
VA252927OtherALLIANCE
VA7618325OtherAETNA
VA102822OtherKAISER
VA202073OtherANTHEM BCBS - PIN
MD520537OtherCARE FIRST
VA659561OtherSOUTHERN HEALTH
VA252927OtherOPTIMUM
VA252927OtherMDIPA
VA2860005OtherAETNA
VA002284081Medicaid
MD419630OtherCARE FIRST
VA85970002OtherCARE FIRST
MD85TZDIOtherCARE FIRST
VA8011510OtherCIGNA
VA85970001OtherCARE FIRST
VAMT35OtherBCBS
VA102822OtherKAISER
FDS016Medicare PIN