1407019201 NPI number — JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES

Table of content: (NPI 1407019201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407019201 NPI number — JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407019201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CRESCENT CENTRE DR STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-7270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-261-2306
Provider Business Mailing Address Fax Number:
855-588-3545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-503-4900
Provider Business Practice Location Address Fax Number:
215-503-4920
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
CANNON
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-846-7733

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com