Wallace Adam Goforth is a Carbondale, Illinois based nurse anesthetist with 8 years of experience as Nurse Anesthetist. He completed he graduation in 2017. He accepts the Medicare-approved amount. Patients will not be billed for any more than the Medicare deductible and coinsurance. Active license number of Wallace Adam Goforth is 209016165 for Anesthesia Administration in Illinois. his current practice location is 405 W Jackson St, Carbondale. Patients can reach him at 618-549-0721. Wallace Adam Goforth with specialization in Nurse Anesthetist and he NPI number (Unique professional ID assigned by NPPES) is 1497295901. Wallace Adam Goforth is a certified registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists.
Complete Profile:
Wallace Adam Goforth speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
Specialization:
Nurse Anesthetist
Experience:
8+ years
Medical School Attended:
Other
Graduation Year:
2017
Gender:
Male
Accepts Medicare Assignment:
Yes
Practice Address:
405 W Jackson St, Carbondale, Illinois, 62901-1462
Phone:
618-549-0721
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
PAC ID:
3476829995
Enrollment ID:
I20200324003185
NPI Number:
1497295901
NPI Enumeration Date:
02 Mar, 2017
NPI Last Update On:
12 Oct, 2022
Medical Licenses:
Nurses can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Wallace Adam Goforth are as mentioned below.
License Number
Specialization
State
Status
209016165
Anesthesia Administration
Illinois
Primary
041.449328
Registered Nurse
Illinois
Secondary
857695
Anesthesia Administration
New York
Secondary
Hospital Affiliation:
Surgeons are affiliated to many hospitals whom they worked with in the past or are presently working with. One surgeon can be affiliated to four to five hospitals at a time.
Hospital Name (CCN)
State
Hospital Type
Willis Knighton Medical Center, Inc (190111)
Shreveport, LA
Acute Care Hospital
Group Practice:
Group practices are run by a group of physicians who share their premises and other resources. Following list states all the group name
with which Wallace Adam Goforth has association with along with the number of members in that group.
Organization Name (Group PAC ID)
Members
Willis Knighton Medical Center Inc Crna Group (1759358674)
72
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
35 Albany Rd Ste C, Carbondale, Illinois
Zip:
62903-7647
Phone Number:
618-457-5111
Fax Number:
--
Patients can reach Wallace Adam Goforth at 405 W Jackson St, Carbondale, Illinois or can call to book an appointment on 618-549-0721.
Comments/ Reviews:
Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 10 March, 2025.