Provider Demographics
| NPI: | 1235180480 |
|---|---|
| Name: | MEDICAL EDUCATION ASSISTANCE CORPORATION |
| Entity Type: | Organization |
| Organization Name: | MEDICAL EDUCATION ASSISTANCE CORPORATION |
| Other - Org Name: | UNIVERSITY PHYSICIANS PRACTICE GROUP |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | RUSSELL |
| Authorized Official - Middle Name: | E |
| Authorized Official - Last Name: | LEWIS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 423-433-6050 |
| Mailing Address - Street 1: | PO BOX 699 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MOUNTAIN HOME |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 37684-0699 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 423-433-6039 |
| Mailing Address - Fax: | 423-433-6060 |
| Practice Address - Street 1: | 101 MED TECH PKWY STE 306 |
| Practice Address - Street 2: | |
| Practice Address - City: | JOHNSON CITY |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 37604-4001 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 423-433-6039 |
| Practice Address - Fax: | 423-433-6060 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-12 |
| Last Update Date: | 2022-04-26 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TN | 0006 | Medicare ID - Type Unspecified | |
| TN | 3714472 | Medicare ID - Type Unspecified | |
| TN | 3714475 | Medicare ID - Type Unspecified | |
| TN | 3714473 | Medicare ID - Type Unspecified | |
| TN | 3715130 | Medicare ID - Type Unspecified | |
| TN | 3981331 | Medicare ID - Type Unspecified | |
| TN | 3714476 | Medicare ID - Type Unspecified | |
| TN | 3714478 | Medicare ID - Type Unspecified | |
| TN | 3714471 | Medicare ID - Type Unspecified | |
| TN | 3714477 | Medicare ID - Type Unspecified | |
| TN | 3981334 | Medicare ID - Type Unspecified | |
| TN | 3714470 | Medicare ID - Type Unspecified | |
| TN | 3714474 | Medicare ID - Type Unspecified | |
| TN | 3715133 | Medicare ID - Type Unspecified | |
| TN | 3714609 | Medicare ID - Type Unspecified | |
| TN | 3921775 | Medicare ID - Type Unspecified | |
| TN | 3981333 | Medicare ID - Type Unspecified | |
| TN | 3353121 | Medicare ID - Type Unspecified |
