Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ft Jesse Imaging Center LLC

Organization Diagnostic Radiology Physician · NPI 1245287143

Ft Jesse Imaging Center LLC is a Diagnostic Radiology Physician in Normal, Illinois. Licensed in Illinois. Registered with an NPI since 2006.

Licensed in
IL
In the registry since
2006
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2200 Fort Jesse Rd Ste 130
Normal, IL 61761-6286
Phone: (309) 454-5552
Fax: (309) 454-5452
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Radiology Clinic/Center (primary) Taxonomy 261QR0200X · Licence 9256804 (IL)
Diagnostic Radiology Physician Taxonomy 2085R0202X
Mammography Clinic/Center Taxonomy 261QR0206X · Licence 9256804 (IL)

Record details

NPI number1245287143
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Amy Stout — President/Ceo · (615) 261-2306
NPI enumeratedMay 27, 2006
Last updated in NPPESDecember 16, 2025
Certification dateDecember 16, 2025
Mailing address2200 Fort Jesse Rd, Suite 130, Normal, IL 61761-6286

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