Healthcare Provider Details

I. General information

NPI: 1679842637
Provider Name (Legal Business Name): MEDICAL EDUCATION ASSISTANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604
US

IV. Provider business mailing address

PO BOX 2204
JOHNSON CITY TN
37605-2204
US

V. Phone/Fax

Practice location:
  • Phone: 423-433-6050
  • Fax: 423-433-6060
Mailing address:
  • Phone: 423-433-6050
  • Fax: 423-433-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD19201
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD19625
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD26210
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD39380
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD40130
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD13109
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD12599
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD45960
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD35095
License Number StateTN
# 10
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD34692
License Number StateTN
# 11
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD43116
License Number StateTN
# 12
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD20802
License Number StateTN
# 13
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD16312
License Number StateTN
# 14
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD25709
License Number StateTN
# 15
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD20468
License Number StateTN

VIII. Authorized Official

Name: RUSSELL E LEWIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 423-433-6050