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General NPI Number Information
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NPI Number | 1780953729
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Entity Type | Organization
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Legal Business Name | MEDICAL EDUCATION ASSISTANCE CORPORATION
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1319 SUNSET DR SUITE 103
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City | JOHNSON CITY
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State | TN
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Zip | 37604-3799
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Country | US
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Telephone | 423-439-7246
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Fax | 423-282-4698
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Provider Business Mailing Address
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Address Line | PO BOX 2204
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City | JOHNSON CITY
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State | TN
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Zip | 37605-2204
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Country | US
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Telephone | 423-433-6050
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Fax | 423-433-6060
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RUSSELL E LEWIS
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Credential |
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Telephone | 423-433-6050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD35556
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | MD35556
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License Number State | TN
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