Organization
MEDICAL EDUCATION ASSISTANCE CORPORATION
Active
Other names
ETSU Dept of Pathology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL E LEWIS (EXECUTIVE DIRECTOR)
(423) 433-6050
Entity
Organization
Contact information
Practice address
BLDG 119, DOGWOOD LN, VETERANS ADMINSTRATION, MOUNTAIN HOME, TN 37684
(423) 439-6210
(423) 439-8060
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 433-6050
(423) 433-6060
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2211
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235200676
LABS GROUP NPI
—
01
—
2211
STATE LICENSE
TN
01
—
44D0659144
CLIA
TN
Enumeration date
11/17/2006
Last updated
08/22/2018
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