Organization
DIGITRACE CARE SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL R. IBERGER (EVP,CFO)
(978) 536-7400
Entity
Organization
Contact information
Practice address
4125 N 124TH ST, SUITE J, BROOKFIELD, WI 53005-1837
(262) 790-4500
(262) 790-1567
Mailing address
200 CORPORATE PL, SUITE 5B, PEABODY, MA 01960-3840
(978) 536-7400
(978) 535-9757
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019876003
—
WI
01
—
196050540331
HUMANA
WI
01
—
208665
ANTHEM
WI
01
—
3501696
UNITED HEALTHCARE
WI
01
—
7618325
AETNA
—
Enumeration date
08/08/2006
Last updated
06/27/2014
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