| Capodice, Efaw, Ocheltree & Elger Pllc | |
|
109 N Regency Dr Bloomington IL 61701-3515 | |
| (309) 663-2526 | |
| (309) 663-4788 |
| Full Name | Capodice, Efaw, Ocheltree & Elger Pllc |
|---|---|
| Speciality | Dentist |
| Location | 109 N Regency Dr, Bloomington, Illinois |
| Authorized Official Name and Position | Kyndra Bata (OFFICE MANAGER) |
| Authorized Official Contact | 3096632526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capodice, Efaw, Ocheltree & Elger Pllc 109 N Regency Dr Bloomington IL 61701-3515 Ph: (309) 663-2526 | Capodice, Efaw, Ocheltree & Elger Pllc 109 N Regency Dr Bloomington IL 61701-3515 Ph: (309) 663-2526 |
| NPI Number | 1710985759 |
|---|---|
| Provider Enumeration Date | 07/13/2005 |
| Last Update Date | 12/20/2023 |
| Medicare PECOS PAC ID | 5597713792 |
|---|---|
| Medicare Enrollment ID | O20050104001014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710985759 | NPI | - | NPPES |
| Provider Name | Jack Capodice |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053397612 PECOS PAC ID: 2668420860 Enrollment ID: I20050105000094 |
| Provider Name | David S Efaw |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1700862877 PECOS PAC ID: 4385692581 Enrollment ID: I20050105000117 |
| Provider Name | Thomas C Ocheltree |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1205892973 PECOS PAC ID: 5395740161 Enrollment ID: I20060929000104 |
| Provider Name | Anthony Mitchell Elger |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1114363579 PECOS PAC ID: 7719277938 Enrollment ID: I20200630001425 |
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