Healthcare Provider Details

I. General information

NPI: 1336546266
Provider Name (Legal Business Name): GOODALL-WITCHER HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E JEFFERSON AVE
WHITNEY TX
76692-2398
US

IV. Provider business mailing address

202 E JEFFERSON AVE
WHITNEY TX
76692-2398
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-2221
  • Fax: 254-694-9978
Mailing address:
  • Phone: 254-674-2221
  • Fax: 254-694-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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