Healthcare Provider Details

I. General information

NPI: 1427978543
Provider Name (Legal Business Name): MAGNOLIA ULTRASOUND IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PEARL ST
SALEM IL
62881-1532
US

IV. Provider business mailing address

20648 W OAK SHORES DR
WALNUT HILL IL
62893-9700
US

V. Phone/Fax

Practice location:
  • Phone: 618-922-6272
  • Fax: 854-238-3132
Mailing address:
  • Phone: 618-694-3955
  • Fax: 854-238-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAMI LYN JENNINGS
Title or Position: OWNER/SONOGRAPHER
Credential: RDMS, RT(R)
Phone: 618-694-3955