# MEDICAL EDUCATION ASSISTANCE CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UNIVERSITY PHYSICIANS PRACTICE GROUP-ETSU FAMILY MEDICINE JOHNSON CITY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013130103
- **Authorized official:** RUSSELL E LEWIS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (423) 433-6050

## Contact information

- **Practice address:** 917 W WALNUT ST, JOHNSON CITY, TN 37604-6527
- **Practice address phone:** (423) 439-6464
- **Practice address fax:** (423) 439-7118
- **Mailing address:** PO BOX 699, MOUNTAIN HOME, TN 37684-0699
- **Mailing address phone:** (423) 433-6039
- **Mailing address fax:** (423) 433-6060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 03/07/2023