Active NPI
Earl E Woeltje Jr
- Dentist
- Streator, IL
National Provider Identifier
1437664976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- EARL E WOELTJE JR
- Practice address
- 712 N Bloomington St
Streator, IL 61364-2087 - Phone
- (815) 672-2195
- NPI assigned
- Dec 6, 2017
- Organization subpart
- Yes
- Parent organization
- -
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Earl Ernst Woeltje Jr., DDS
- Title
- Owner
- Phone
- (815) 672-2195
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | Primary | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
712 N Bloomington St
Streator, IL 61364-2087
Mailing address
PO Box 516
Streator, IL 61364-0516
Phone (815) 672-2195
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240116001078 | IL | DME Supplier - Oral Surgery - Dentist | 3779935796 | Practice locations: Streator, IL |
National Provider Directory
National Provider Directory- Part of
- Earl E Woeltje Jr
Locations
712 N Bloomington St
Streator, IL 61364
Phone (815) 672-2195
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dentist
- Streator, IL
- NPI 1235347279
-
- Chiropractor
- Streator, IL
- NPI 1871587139
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512518400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1700006400000",
"number": "1437664976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 516",
"city": "STREATOR",
"state": "IL",
"postal_code": "613640516",
"telephone_number": "815-672-2195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 N BLOOMINGTON ST",
"city": "STREATOR",
"state": "IL",
"postal_code": "613642087",
"telephone_number": "815-672-2195"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EARL E WOELTJE JR",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "-",
"enumeration_date": "2017-12-06",
"last_updated": "2023-11-15",
"certification_date": "2023-11-15",
"status": "A",
"authorized_official_last_name": "WOELTJE",
"authorized_official_first_name": "EARL",
"authorized_official_middle_name": "ERNST",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "815-672-2195",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist",
"state": null,
"license": null,
"primary": true
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Streator, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.