Provider Demographics
NPI:1497839823
Name:FOOT AND ANKLE CLINIC OF SPOKANE INC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF SPOKANE INC
Other - Org Name:SURGERY CENTER OF SPOKANE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER- DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:BABOL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-928-8181
Mailing Address - Street 1:9116 E SPRAGUE AVE # 278
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3601
Mailing Address - Country:US
Mailing Address - Phone:509-928-8181
Mailing Address - Fax:509-926-1247
Practice Address - Street 1:205 N UNIVERSITY RD STE 4
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5094
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:2006-10-24
Last Update Date:2008-04-20
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
WA0166415OtherL & I
WA1116623Medicaid
WA61101OtherHUMANA
WA480034678OtherRAILROAD
WA693OBOOtherASURIS
WA=========OtherCOMMERCIAL
WAU37750Medicare UPIN
WA480034678OtherRAILROAD
WAGAB38434Medicare PIN