1639398159 NPI number — DIGITRACE CARE SERVICES INC

Table of content: (NPI 1639398159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639398159 NPI number — DIGITRACE CARE SERVICES INC

Organization/Personal Information

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's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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 Information

NPI Number:
1639398159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2303 BEL AIR RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
FALLSTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21047-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-877-3950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

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

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 292359 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 071500008 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 292359 . This is a "ONENET PPO" 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: 292359 . This is a "MDIPA" 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: 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".
  • Identifier: 85970001 . This is a "CARE FIRST" identifier , issued by the state of ( VA ) . 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".




Copyright © 2007-2025 www.npivalidator.com