Healthcare Provider Details

I. General information

NPI: 1184666026
Provider Name (Legal Business Name): GOODALL-WITCHER HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 POSEY AVE
CLIFTON TX
76634-1855
US

IV. Provider business mailing address

PO BOX 72
CLIFTON TX
76634-0072
US

V. Phone/Fax

Practice location:
  • Phone: 254-675-8621
  • Fax: 254-675-2254
Mailing address:
  • Phone: 254-675-8621
  • Fax: 254-675-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM WILLMANN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 254-675-8322