Healthcare Provider Details

I. General information

NPI: 1588470348
Provider Name (Legal Business Name): ALASKA PEDIATRIC MIND AND BODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W 8TH AVE STE 101
ANCHORAGE AK
99501-3340
US

IV. Provider business mailing address

911 W 8TH AVE STE 101
ANCHORAGE AK
99501-3340
US

V. Phone/Fax

Practice location:
  • Phone: 907-206-7707
  • Fax:
Mailing address:
  • Phone: 907-206-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHRISTOPHER DRISCOLL
Title or Position: OWNER
Credential: MD
Phone: 907-206-7707