Organization
DIGITRACE CARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL IBERGER (EVP/CFO)
(978) 536-7400
Entity
Organization
Contact information
Practice address
11790 SW BARNES RD, SUITE 330, PORTLAND, OR 97225-5934
(978) 536-7400
Mailing address
60 CHASTAIN CENTER BLVD NW, SUITE 66, KENNESAW, GA 30144-5598
(770) 592-5544
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7618325
AETNA
—
Enumeration date
01/28/2008
Last updated
10/15/2009
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