Provider Demographics
NPI:1902114168
Name:JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES, LLC
Other - Org Name:JEFFERSON OUTPATIENT IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-846-7733
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7270
Mailing Address - Country:US
Mailing Address - Phone:615-261-2306
Mailing Address - Fax:855-588-3545
Practice Address - Street 1:1 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1513
Practice Address - Country:US
Practice Address - Phone:615-277-3202
Practice Address - Fax:610-277-9640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ255184OtherMEDICARE IDTF (MOBILE PET/CT)
PA205517OtherMEDICARE IDTF (MOBILE PET/CT)