1154576114 NPI number — JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154576114 NPI number — JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES LLC
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:
6
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:
1154576114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
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:
534 2ND AVE # RT.29
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
COLLEGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19426-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-831-0500
Provider Business Practice Location Address Fax Number:
610-831-8989
Provider Enumeration Date:
11/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STOUT
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
615-261-2306

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)





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