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Organization
JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES LLC
Active
Organization
JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES LLC
Active
Other names
Jefferson Outpatient Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
AMY STOUT (PRESIDENT/CEO)
(615) 261-2306
Entity
Organization
Contact information
Practice address
850 WALNUT ST, PHILADELPHIA, PA 19107-5102
(215) 503-4900
(215) 503-4920
Mailing address
800 CRESCENT CENTRE DR STE 400, FRANKLIN, TN 37067-7270
(615) 261-2306
(855) 588-3545
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001462197
BLUE CROSS
PA
05
—
0078124910002
—
PA
Enumeration date
05/09/2006
Last updated
12/16/2025
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