MEDICARE: DIGITRACE CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1033340294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGITRACE CARE SERVICES

Provider Business Mailing Address
First Line	:	200 CORPORATE PL
Second Line	:	5B
City	:	PEABODY
State	:	MA
Zip	:	01960-3840
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:	978-535-9757

Provider Business Practice Location Address
First Line	:	7635 W OKLAHOMA AVE
Second Line	:	105
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-3600
Country	:	US
Telephone Number	:	414-543-0554
Fax Number	:

Authorized Official
Title or Position	:	CFO, EVP
Name	:	MR. CARL IBERGER
Credential	:
Telephone Number	:	978-536-7400

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	08/05/2009

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