Organization
FT. JESSE IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY STOUT (PRESIDENT/CEO)
(615) 261-2306
Entity
Organization
Contact information
Practice address
2200 FORT JESSE RD, NORMAL, IL 61761-6286
(309) 454-5552
Mailing address
840 CRESCENT CENTRE DR STE 200, FRANKLIN, TN 37067-4652
(615) 261-2306
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46015604001
—
IL
Enumeration date
01/08/2018
Last updated
10/21/2024
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