NPIMap

Organization Active NPI

Medicaleducationassistancecorporationdbauniversityphysicianspracticegr

  • Clinical Medical Laboratory
  • Johnson City, TN
National Provider Identifier
1891861373
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
3333 Issued in TN
Legal business name
MEDICALEDUCATIONASSISTANCECORPORATIONDBAUNIVERSITYPHYSICIANSPRACTICEGR
Practice address
325 N State of Franklin Rd
Johnson City, TN 37604
Phone
(423) 439-7272
Fax
(423) 439-7235
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Russell E Lewis
Title
Executive Director
Phone
(423) 433-6050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 3333 TN Primary

Addresses

Primary practice location

325 N State of Franklin Rd
Johnson City, TN 37604

Mailing address

PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 433-6000

Other identifiers 1

IdentifierTypeStateIssuer
44D0718613OtherTNCLIA ID NUMBER

Other names 1

  • ETSU ANDROLOGY LAB Other name

National Provider Directory

National Provider Directory
Tax ID family
Univ Phy Prac Group27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534896000000",
    "number": "1891861373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-433-6000",
            "fax_number": "423-433-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N STATE OF FRANKLIN RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-439-7272",
            "fax_number": "423-439-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICALEDUCATIONASSISTANCECORPORATIONDBAUNIVERSITYPHYSICIANSPRACTICEGR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2018-08-22",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "423-433-6050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "3333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID NUMBER",
            "identifier": "44D0718613",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETSU ANDROLOGY LAB",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "ETSU ANDROLOGY LAB",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.