FT. JESSE IMAGING CENTER LLC; NPI #1245287143

Contact Information

FT. JESSE IMAGING CENTER LLC

2200 FORT JESSE RD
SUITE 130
NORMAL, IL 61761-6286

Phone: 309-454-5552
Fax: 309-454-5452
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Radiology	261QR0200X	74	Radiation Therapy Center
Diagnostic Radiology	2085R0202X	30	Physician/Diagnostic Radiology
Radiology, Mammography	261QR0206X

Indicates primary specialty

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NPI Profile & details for FT. JESSE IMAGING CENTER LLC

NPI Number 1245287143

LBN Legal business name FT. JESSE IMAGING CENTER LLC

Authorized official AMY STOUT - (PRESIDENT/CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/27/2006

Last updated 12/16/2025 - About 6 months ago

Identifiers

IL	License #	9256804
IL	Medicaid	46015604001

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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