Provider Demographics
NPI:1740461805
Name:A HOME OF HAPPY FEET PS
Entity type:Organization
Organization Name:A HOME OF HAPPY FEET PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-838-2929
Mailing Address - Street 1:225 E 3RD AVE
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1422
Mailing Address - Country:US
Mailing Address - Phone:509-838-2929
Mailing Address - Fax:509-838-2920
Practice Address - Street 1:225 E 3RD AVE
Practice Address - Street 2:SUITE # 5
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1422
Practice Address - Country:US
Practice Address - Phone:509-838-2929
Practice Address - Fax:509-838-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA312261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8869612OtherINDIVIDUAL PTAN NUMBER
WA7141096Medicaid
WA6077730001Medicare NSC