Provider Demographics
NPI:1124109590
Name:FOOT AND ANKLE CLINIC OF SPOKANE INC
Entity type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF SPOKANE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:BABOL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-928-8181
Mailing Address - Street 1:9116 E SPRAGUE AVE
Mailing Address - Street 2:STE 278
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3694
Mailing Address - Country:US
Mailing Address - Phone:509-928-8181
Mailing Address - Fax:509-926-1247
Practice Address - Street 1:205 N UNIVERSITY RD STE 5
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5094
Practice Address - Country:US
Practice Address - Phone:509-928-8181
Practice Address - Fax:509-926-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000715332BC3200X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9055492Medicaid
WA9055492Medicaid