Wallace Adam Goforth is a Carbondale, Illinois based nurse anesthetist with 8 years of experience as Anesthesia Administration. 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 1113831 for Anesthesia Administration in Texas. his current practice location is 405 W Jackson St, Carbondale. Patients can reach him at 618-549-0721. Wallace Adam Goforth is CRNA with specialization in Anesthesia Administration 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: | Anesthesia Administration |
| Credentials: | CRNA |
| 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: | 09 Oct, 2025 |
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 | |
| 1113831 | Anesthesia Administration | Texas | Primary | |
| 209016165 | Anesthesia Administration | Illinois | Secondary | |
| 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 13 October, 2025.