MEDICARE: BJC OUTPATIENT IMAGING 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

General Provider Information

NPI Number	:	1710781414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BJC OUTPATIENT IMAGING 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	:	1785 CLARKSON RD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-4966
Country	:	US
Telephone Number	:	636-681-1540
Fax Number	:	636-681-1541

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

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	01/16/2026

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