1003035510 NPI number — DIGITRACE CARE SERVICES INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003035510 NPI number — DIGITRACE CARE SERVICES INC

Employer Identification Number (EIN):

Provider Organization Name:

DIGITRACE CARE SERVICES INC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

SLEEPMED

Provider Other Organization Name Type Code:

3

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1003035510

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

05/17/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

200 CORPORATE PL

Provider Second Line Business Mailing Address:

SUITE 5B

Provider Business Mailing Address City Name:

PEABODY

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01960-3840

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-536-7400

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

6931 ARLINGTON RD

Provider Second Line Business Practice Location Address:

T300-A

Provider Business Practice Location Address City Name:

BETHESDA

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20814-5231

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-251-5905

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/24/2007

Authorized Official Last Name:

ROSE

Authorized Official First Name:

JOSEPH

Authorized Official Middle Name:

Authorized Official Title or Position:

VP OF FINANCE & ADMINISTRATION

Authorized Official Telephone Number:

978-536-7400

• Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 071500005 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 292359 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 292359 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 292359 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 659561 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 292359 . This is a "ONENET PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 419630 . This is a "CARE FIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 85970002 . This is a "CARE FIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 85970001 . This is a "CARE FIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 8597001 . This is a "CARE FIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 520537 . This is a "CARE FIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 85TZDI . This is a "CARE FIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".