Healthcare Provider Details

I. General information

NPI: 1538016126
Provider Name (Legal Business Name): BJC OUTPATIENT IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 TECHNOLOGY DR STE 110
O FALLON MO
63368-7342
US

IV. Provider business mailing address

800 CRESCENT CENTRE DR STE 400
FRANKLIN TN
37067-7270
US

V. Phone/Fax

Practice location:
  • Phone: 636-681-1540
  • Fax:
Mailing address:
  • Phone: 615-261-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY STOUT
Title or Position: CEO
Credential:
Phone: 615-261-2306