Healthcare Provider Details

I. General information

NPI: 1255300182
Provider Name (Legal Business Name): TERRENCE WESLEY LEVECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 HOSPITAL LN JELLICO COMMUNITY HOSPITAL
JELLICO TN
37762-4400
US

IV. Provider business mailing address

454 PLANTATION BLVD
LEBANON TN
37087-3260
US

V. Phone/Fax

Practice location:
  • Phone: 800-944-7252
  • Fax: 800-305-3233
Mailing address:
  • Phone: 615-444-3027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20446
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: