Provider Demographics
NPI:1588470348
Name:ALASKA PEDIATRIC MIND AND BODY LLC
Entity type:Organization
Organization Name:ALASKA PEDIATRIC MIND AND BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-206-7707
Mailing Address - Street 1:911 W 8TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3340
Mailing Address - Country:US
Mailing Address - Phone:907-206-7707
Mailing Address - Fax:
Practice Address - Street 1:911 W 8TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3340
Practice Address - Country:US
Practice Address - Phone:907-206-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty