Provider Demographics
NPI:1598986531
Name:GOODALL-WITCHER HEALTHCARE FOUNDATION
Entity Type:Organization
Organization Name:GOODALL-WITCHER HEALTHCARE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CHE
Authorized Official - Phone:254-675-8322
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-0549
Mailing Address - Country:US
Mailing Address - Phone:254-675-8322
Mailing Address - Fax:254-675-2246
Practice Address - Street 1:101 S AVENUE T
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1832
Practice Address - Country:US
Practice Address - Phone:254-675-8322
Practice Address - Fax:254-675-2246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODALL-WITCHER HEALTHCARE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-01
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000070332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0422480002Medicare NSC