Basic Information
| Provider Information | |||||||||
| NPI: | 1023226438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL EDUCATION ASSISTANCE CORPORATION | ||||||||
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| OtherOrganizationName: | ETSU OSTEOPOROSIS CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 699 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376840699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234336039 | ||||||||
| FaxNumber: | 4234336060 | ||||||||
| Practice Location | |||||||||
| Address1: | 2109 W MARKET ST | ||||||||
| Address2: | ROOM 143 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234398830 | ||||||||
| FaxNumber: | 4234398580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4234336050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0208X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile |
ID Information
| ID | Type | State | Issuer | Description | 3790481 | 01 | TN | MEDICARE | OTHER | 44X0009820 | 01 | TN | PORTABLE X-RAY ID NUMBER | OTHER |