Provider Demographics
NPI:1396117305
Name:INLAND NORTHWEST FAMILY FOOTCARE, PLLC
Entity type:Organization
Organization Name:INLAND NORTHWEST FAMILY FOOTCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:MACLENNAN
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-926-1559
Mailing Address - Street 1:1215 N MCDONALD RD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1557
Mailing Address - Country:US
Mailing Address - Phone:509-926-1559
Mailing Address - Fax:509-926-1550
Practice Address - Street 1:1215 N MCDONALD RD
Practice Address - Street 2:SUITE #201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1557
Practice Address - Country:US
Practice Address - Phone:509-926-1559
Practice Address - Fax:509-926-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA464213ES0000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1080274Medicaid
WA480012182OtherRAILROAD MEDICARE
WA1080274Medicaid