Healthcare Provider Details

I. General information

NPI: 1396896296
Provider Name (Legal Business Name): DIGITRACE CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11250 CORPORATE AVE
LENEXA KS
66219-1392
US

IV. Provider business mailing address

200 CORPORATE PL
PEABODY MA
01960-3840
US

V. Phone/Fax

Practice location:
  • Phone: 978-536-7400
  • Fax:
Mailing address:
  • Phone: 978-536-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CARL R IBERGER
Title or Position: EVP CFO
Credential:
Phone: 978-536-7400