Healthcare Provider Details

I. General information

NPI: 1114382553
Provider Name (Legal Business Name): FOOT AND ANKLE CLINIC OF SPOKANE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MCKINLEY AVE
KELLOGG ID
83837-2693
US

IV. Provider business mailing address

9116 E SPRAGUE AVE # 278
SPOKANE VALLEY WA
99206-3601
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-8181
  • Fax:
Mailing address:
  • Phone: 509-928-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP218
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberP218
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberP218
License Number StateID

VIII. Authorized Official

Name: DR. JACQUELINE M BABOL
Title or Position: OWNER- DOCTOR
Credential: DPM
Phone: 509-928-8181