Healthcare Provider Details

I. General information

NPI: 1609958719
Provider Name (Legal Business Name): COMMUNITY IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 HARRISON ST
BELLWOOD IL
60104
US

IV. Provider business mailing address

270 WEST LOOP RD
WHEATON IL
60187
US

V. Phone/Fax

Practice location:
  • Phone: 708-493-9500
  • Fax: 708-493-9574
Mailing address:
  • Phone: 630-653-8464
  • Fax: 630-653-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON R JESTER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 630-653-8464