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	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	:	1982881454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGITRACE CARE SERVICES INC

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	:	3921 SUNSET RIDGE RD
Second Line	:	SUITE 103
City	:	RALEIGH
State	:	NC
Zip	:	27607-6677
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:

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

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	10/15/2009

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