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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7618325	OTHER		AETNA

General Provider Information

NPI Number	:	1245417963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGITRACE CARE SERVICES

Provider Business Mailing Address
First Line	:	60 CHASTAIN CENTER BLVD NW
Second Line	:	SUITE 66
City	:	KENNESAW
State	:	GA
Zip	:	30144-5598
Country	:	US
Telephone Number	:	770-592-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 MAR WALT DR
Second Line	:	SUITE 2021
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6960
Country	:	US
Telephone Number	:	850-863-0006
Fax Number	:

Authorized Official
Title or Position	:	VP OF FINANCE & ADMINISTRATION
Name	:	JOSEPH ROSE
Credential	:
Telephone Number	:	978-536-7400

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	05/20/2016

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