Provider Demographics
NPI:1780953729
Name:MEDICAL EDUCATION ASSISTANCE CORPORATION
Entity type:Organization
Organization Name:MEDICAL EDUCATION ASSISTANCE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1319 SUNSET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3799
Practice Address - Country:US
Practice Address - Phone:423-439-7246
Practice Address - Fax:423-282-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35556207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714470Medicare PIN