Bosque County Hospital District
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Clifton, TX
NPI 1154883692 · NPPES record last updated Aug 10, 2022
Key facts
- NPI
- 1154883692
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- Legal business name
- BOSQUE COUNTY HOSPITAL DISTRICT
- Practice address
- 101 Posey Ave
Clifton, TX 76634-1289 - Phone
- (254) 675-8322
- Fax
- (254) 675-2246
- NPI assigned
- Apr 3, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- BOSQUE COUNTY HOSPITAL DISTRICT
Authorized official
- Name
- Adam Willmann
- Title
- President/Ceo
- Phone
- (254) 675-8322
Owners & managing parties with NPI records 5
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 6
Related certifications (CCN) 1
Facilities with the same owner 5
Practitioners 30
-
Courtney Lynn Bagley, MSN-FNP
-
Skylar Kirk Bizzell, M.D.
-
Don Randall Bostick, FNP-C
-
Rodney A. Brown, M.D.
-
Peter E Cornell, DPM
-
Brandi Kay Eakin, PA-C
-
Colton Gloff, CRNA
-
Jennifer E Hudson, FNP-C
-
Jamie Lee, APRN, FNP-C
-
Taylor McCain, DO
-
Brennen Puryear, D.O.
-
Lance C Robinson, MD
-
Brandy Lee Schlasman, LMSW
-
Carter T Smith, M.D.
-
Justin D Squyres, MD
-
Jodie Tarver, LPC
-
Malinda Lee Webb, M.S., LPC
Affiliated clinicians 2
-
Justin D Squyres, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospital certification: CCN 45Z385
- Legal name
- BOSQUE COUNTY HOSPITAL DISTRICT
- Doing business as
- GOODALL-WITCHER HOSPITAL
- Organization structure
- Other · Non-profit
- Enrollment address
- 101 Posey Ave
Clifton, TX 76634-1289
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Vicki Gloff |
Corporate Director |
Dec 1, 2014 | |
| W-2 Managing Employee |
Dec 1, 2014 | ||
| Jerry L Pickett |
Corporate Director |
Jun 24, 2019 | |
| W-2 Managing Employee |
Jun 24, 2019 | ||
| Charles Hopkins |
Corporate Officer |
Jan 14, 2019 | |
| Roger Parks |
Corporate Officer |
Jan 14, 2019 | |
| Bosque County Hospital District |
5% Or Greater Direct Ownership Interest | Jul 1, 2019 | 100% |
| Operational/Managerial Control | Jul 1, 2019 | 100% | |
| Thomas Blossom |
Corporate Director |
May 22, 2020 | |
| Virginia Villarreal |
Corporate Officer |
Jan 14, 2019 | |
| George Clifton |
Corporate Officer |
Jan 14, 2019 | |
| Adam B Willmann |
Corporate Director |
Dec 1, 2014 | |
| W-2 Managing Employee |
Dec 1, 2014 | ||
| Robert Phillips |
Corporate Officer |
May 1, 2023 | |
| John Erickson |
Corporate Officer |
Jan 14, 2019 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Goodall-Witcher Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 1, 2019 Jul 1, 2019 |
| Sunset Home |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jul 1, 2019 Jul 1, 2019 Jul 2, 2025 |
| Goodall-Witcher Home Health Agency |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2019 |
| Goodall-Witcher Clinic in Clifton |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2019 |
| Goodall-Witcher Clinic in Whitney |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190610000200 | TX | Part a Provider - Critical Access Hospital | 4587997754 | Practice locations: Clifton, TX |
National Provider Directory
- Tax ID family
- Bosque County Hospital District
- Part of
- Bosque County Hospital District
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
101 Posey Ave
Clifton, TX 76634-1289
Mailing address
PO Box 549
Clifton, TX 76634-0549
Phone (254) 675-8322
Other names
- Goodall-Witcher Hospital
Other providers in Clifton, TX
- Melinda Sue Bell
- Charles Tobin-Adam Bellows
- Skylar Kirk Bizzell
- Kevin J Blanton
- Bosque County Hospital District
- Bosque County Hospital District
- Bosque County Hospital District
- Bosque County Hospital District
- Bosque County Hospital District
- Don Randall Bostick
All providers in Clifton, TX · Medicare Defined Swing Bed Hospital Unit in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.