MEDICARE: DIGITRACE CARE SERVICES, INC

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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SF038169	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1528262235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGITRACE CARE SERVICES, INC

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

Provider Business Practice Location Address
First Line	:	370 FAUNCE CORNER RD
Second Line	:
City	:	NORTH DARTMOUTH
State	:	MA
Zip	:	02747-1271
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	10/15/2009

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