Provider Demographics
NPI:1285626622
Name:FOOT & ANKLE CLINIC OF SPOKANE
Entity Type:Organization
Organization Name:FOOT & ANKLE CLINIC OF SPOKANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BABOL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-928-8181
Mailing Address - Street 1:9405 E SPRAGUE AVE
Mailing Address - Street 2:POB 13070
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3694
Mailing Address - Country:US
Mailing Address - Phone:509-928-8181
Mailing Address - Fax:509-926-1247
Practice Address - Street 1:9405 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3694
Practice Address - Country:US
Practice Address - Phone:509-928-8181
Practice Address - Fax:509-926-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000715213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA693OBOOtherREGENCE
WA1116623Medicaid
WA4797370001OtherDMERC PIN
WA9055492OtherDSHS DMERC
WA9055492OtherDSHS DMERC
WAU37750Medicare UPIN
WA4797370001OtherDMERC PIN