MEDICARE: JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001462197	OTHER	PA	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578512224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	800 CRESCENT CENTRE DR STE 400
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7270
Country	:	US
Telephone Number	:	615-261-2306
Fax Number	:	855-588-3545

Provider Business Practice Location Address
First Line	:	850 WALNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5102
Country	:	US
Telephone Number	:	215-503-4900
Fax Number	:	215-503-4920

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	AMY STOUT
Credential	:
Telephone Number	:	615-261-2306

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	12/16/2025

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