Provider Demographics
NPI:1679696264
Name:GOODALL-WITCHER HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:GOODALL-WITCHER HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:76634-1289
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 HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100188275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45Z385Medicare Oscar/Certification
TX45U052Medicare Oscar/Certification