FT. JESSE IMAGING CENTER LLC NPI 1245287143

NPI Information

NPI: 1245287143
Provider Name: FT. JESSE IMAGING CENTER LLC
Classification: Radiology - 2085R0202X
Entity Type: Organization

Specialization: Diagnostic Radiology

Address:
2200 FORT JESSE RD
SUITE 130
NORMAL, IL
ZIP 61761
Phone: (309) 454-5552
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FT. JESSE IMAGING CENTER LLC is a diagnostic radiology radiology in Normal, IL. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. FT. JESSE IMAGING CENTER LLC NPI is 1245287143. The provider is registered as an organization entity type.

The provider's business location address is:

2200 FORT JESSE RD
SUITE 130
NORMAL, IL
ZIP 61761-286
Phone: (309) 454-5552
Fax: (309) 454-5452

The provider's authorized official is Janet Hawkins .
The authorized official title is Operations Coordinator and has the following contact phone number (309) 454-5552.

The enumeration date for this NPI number is 5/27/2006 and was last updated on 3/16/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0200X	Clinic/Center	Radiology	9256804	ILLINOIS	No
2	261QR0206X	Clinic/Center	Radiology, Mammography	9256804	ILLINOIS	No
3	2085R0202X	Radiology	Diagnostic Radiology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	46015604001	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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