Provider Demographics
NPI:1598940793
Name:MEDICAL EDUCATION ASSISTANCE CORPORATION
Entity Type:Organization
Organization Name:MEDICAL EDUCATION ASSISTANCE CORPORATION
Other - Org Name:BUC SPORTS/UNIVERSITY PHYSICIANS PRACTICE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
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 2204
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37605-2204
Mailing Address - Country:US
Mailing Address - Phone:423-433-6050
Mailing Address - Fax:423-433-6060
Practice Address - Street 1:ETSU MINI-DOME, JOHN ROBERT BELL DRIVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-1700
Practice Address - Country:US
Practice Address - Phone:423-439-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446664Medicare PIN