Healthcare Provider Details

I. General information

NPI: 1710492764
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CARNEGIE BOULEVARD
MALVERN PA
19355-1935
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 615-261-2306
  • Fax:
Mailing address:
  • Phone: 615-261-2306
  • Fax: 855-588-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

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