MEDICARE: FOOT & ANKLE CLINIC OF SPOKANE

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO00000715	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	693OBO	OTHER	WA	REGENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4797370001	OTHER	WA	DMERC PIN
4	9055492	OTHER	WA	DSHS DMERC

General Provider Information

NPI Number	:	1285626622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT & ANKLE CLINIC OF SPOKANE

Provider Business Mailing Address
First Line	:	9405 E SPRAGUE AVE
Second Line	:	POB 13070
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-3694
Country	:	US
Telephone Number	:	509-928-8181
Fax Number	:	509-926-1247

Provider Business Practice Location Address
First Line	:	9405 E SPRAGUE AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-3694
Country	:	US
Telephone Number	:	509-928-8181
Fax Number	:	509-926-1247

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. JACQUELINE M BABOL
Credential	:	DPM
Telephone Number	:	509-928-8181

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/22/2020

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Directions to “FOOT & ANKLE CLINIC OF SPOKANE ” Practice Location

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