Provider Demographics
NPI:1942379896
Name:BILLDT INCORPORATED
Entity Type:Organization
Organization Name:BILLDT INCORPORATED
Other - Org Name:CASCADE MEDICAL CENTER PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLDT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-435-2810
Mailing Address - Street 1:326 S STILLAGUAMISH AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 S STILLAGUAMISH AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1652
Practice Address - Country:US
Practice Address - Phone:360-435-2810
Practice Address - Fax:360-435-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00002229333600000X
3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4901939OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WA6132708Medicaid
4901939OtherOTHER ID NUMBER-COMMERCIAL NUMBER