Healthcare Provider Details

I. General information

NPI: 1124109590
Provider Name (Legal Business Name): FOOT AND ANKLE CLINIC OF SPOKANE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N UNIVERSITY RD STE 5
SPOKANE VALLEY WA
99206-5094
US

IV. Provider business mailing address

9116 E SPRAGUE AVE STE 278
SPOKANE VALLEY WA
99206-3694
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-8181
  • Fax: 509-926-1247
Mailing address:
  • Phone: 509-928-8181
  • Fax: 509-926-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO00000715
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPO00000715
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPO00000715
License Number StateWA

VIII. Authorized Official

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