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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