Healthcare Provider Details

I. General information

NPI: 1962455832
Provider Name (Legal Business Name): GOODALL-WITCHER HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 POSEY AVE
CLIFTON TX
76634-1832
US

IV. Provider business mailing address

PO BOX 549
CLIFTON TX
76634-0549
US

V. Phone/Fax

Practice location:
  • Phone: 254-675-8322
  • Fax: 254-675-2246
Mailing address:
  • Phone: 254-675-8322
  • Fax: 254-675-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number100188
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number100188
License Number StateTX

VIII. Authorized Official

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