Provider Demographics
NPI:1609958719
Name:COMMUNITY IMAGING LLC
Entity type:Organization
Organization Name:COMMUNITY IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:R
Authorized Official - Last Name:JESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-653-8464
Mailing Address - Street 1:270 WEST LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-653-8464
Mailing Address - Fax:630-653-8660
Practice Address - Street 1:2615 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104
Practice Address - Country:US
Practice Address - Phone:708-493-9500
Practice Address - Fax:708-493-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-60104-01Medicaid
IL=========-60104-01Medicaid