Ft. Jesse Imaging Center Llc

LBN: Ft. Jesse Imaging Center Llc
Ft. Jesse Imaging Center Llc is an health care organization with primary practice located at 2200 Fort Jesse Rd , Normal IL 61761-6286. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as the primary health care specialty. Ft. Jesse Imaging Center Llc can be contacted via phone (309) 454-5552, or through Stout, Amy via phone (615) 261-2306.

Contact Information

Primary practice address
2200 Fort Jesse Rd Normal IL 61761-6286
Phone: (309) 454-5552
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Stout, Amy
Phone: (615) 261-2306

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X

Profile Details

NPI number 1104333491
LBN Legal business name Ft. Jesse Imaging Center Llc
DBA Doing business as
Authorized official Stout, Amy
Entity Organization
Organization subpart 1 No
Enumeration date Jan 8th, 2018
Last updated Oct 21st, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104333491 NPPES
Illinois MEDICAID 46015604001

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