Provider Demographics
NPI:1962455832
Name:GOODALL-WITCHER HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:GOODALL-WITCHER HOSPITAL AUTHORITY
Other - Org Name:GOODALL-WITCHER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
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 POSEY AVE
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 261QA1903X
TX100188282NC0060X, 282NR1301X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137075112Medicaid
TX137075118Medicaid
TX137075117Medicaid
TX137075116Medicaid
TX319456Medicare PIN
TX137075112Medicaid
TX137075116Medicaid
TX450052Medicare Oscar/Certification
TX450052Medicare Oscar/Certification
TX00F24LMedicare PIN