MEDICARE: MOUNTAIN PEDIATRICS, P.C.

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1336438142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN PEDIATRICS, P.C.

Provider Business Mailing Address
First Line	:	31955 CASTLE CT
Second Line	:	SUITE 2 SOUTH
City	:	EVERGREEN
State	:	CO
Zip	:	80439-3507
Country	:	US
Telephone Number	:	720-375-5798
Fax Number	:

Provider Business Practice Location Address
First Line	:	31955 CASTLE CT
Second Line	:	SUITE 2 SOUTH
City	:	EVERGREEN
State	:	CO
Zip	:	80439-3507
Country	:	US
Telephone Number	:	720-375-5798
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	VALERI J LESWING
Credential	:
Telephone Number	:	720-375-5798

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	05/16/2011

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