Healthcare Provider Details

I. General information

NPI: 1255538195
Provider Name (Legal Business Name): DIGITRACE CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W SILVER SPRING DR SUITE 5
GLENDALE WI
53209-4217
US

IV. Provider business mailing address

200 CORPORATE PL SUITE 5B
PEABODY MA
01960-3840
US

V. Phone/Fax

Practice location:
  • Phone: 262-790-4500
  • Fax:
Mailing address:
  • Phone: 800-334-5085
  • 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: CARL IBERGER
Title or Position: CFO
Credential:
Phone: 800-334-5085