Healthcare Provider Details

I. General information

NPI: 1407019201
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 WALNUT ST
PHILADELPHIA PA
19107-5109
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 215-503-4900
  • Fax: 215-503-4920
Mailing address:
  • Phone: 615-261-2306
  • Fax: 855-588-3545

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: PRESIDENT/CEO
Credential:
Phone: 615-261-2306