# NOOKSACK CENTRAL MANAGEMENT SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NOOKSACK COMMUNITY CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568528842
- **Authorized official:** JOHN DUNCAN (NIT CONTROLLER)
- **Authorized official phone:** (360) 296-2315

## Contact information

- **Practice address:** 6760 MISSION RD, EVERSON, WA 98247-9749
- **Practice address phone:** (360) 966-2106
- **Practice address fax:** (360) 966-7227
- **Mailing address:** PO BOX 157, DEMING, WA 98244-0157
- **Mailing address phone:** (360) 966-2106
- **Mailing address fax:** (360) 966-7227

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/29/2006
- **Last updated:** 03/02/2009