| Earl E Woeltje Jr | |
|
712 N Bloomington St Streator IL 61364-2087 | |
| (815) 672-2195 | |
| Not Available |
| Full Name | Earl E Woeltje Jr |
|---|---|
| Speciality | Dentist |
| Location | 712 N Bloomington St, Streator, Illinois |
| Authorized Official Name and Position | Earl Ernst Woeltje (OWNER) |
| Authorized Official Contact | 8156722195 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Earl E Woeltje Jr Po Box 516 Streator IL 61364-0516 Ph: (815) 672-2195 | Earl E Woeltje Jr 712 N Bloomington St Streator IL 61364-2087 Ph: (815) 672-2195 |
| NPI Number | 1437664976 |
|---|---|
| Provider Enumeration Date | 12/06/2017 |
| Last Update Date | 11/15/2023 |
| Medicare PECOS PAC ID | 3779935796 |
|---|---|
| Medicare Enrollment ID | O20240116001078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437664976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
John M Conness Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 211 Armory Ct, Streator, IL 61364 Phone: 815-672-2080 Fax: 815-672-4119 |