MEDICARE: MOUNTAIN PEDIATRIC TELEHEALTH LLC

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	:	1588470348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN PEDIATRIC TELEHEALTH LLC

Provider Business Mailing Address
First Line	:	911 W 8TH AVE STE 101
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99501-3340
Country	:	US
Telephone Number	:	907-206-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 W 8TH AVE STE 101
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99501-3340
Country	:	US
Telephone Number	:	907-206-7707
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER DRISCOLL
Credential	:	MD
Telephone Number	:	907-206-7707

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	03/09/2026

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