Healthcare Provider Details

I. General information

NPI: 1023226438
Provider Name (Legal Business Name): MEDICAL EDUCATION ASSISTANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 W MARKET ST ROOM 143
JOHNSON CITY TN
37604-6024
US

IV. Provider business mailing address

PO BOX 699
MOUNTAIN HOME TN
37684-0699
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-8830
  • Fax: 423-439-8580
Mailing address:
  • Phone: 423-433-6039
  • Fax: 423-433-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

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