Healthcare Provider Details

I. General information

NPI: 1548252968
Provider Name (Legal Business Name): FOOT AND ANKLE CLINIC OF SPOKANE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N UNIVERSITY RD STE 4
SPOKANE VALLEY WA
99206-5094
US

IV. Provider business mailing address

9116 E SPRAGUE AVE STE 278
SPOKANE VALLEY WA
99206
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number50-C0001051
License Number StateWA

VIII. Authorized Official

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