MEDICARE: TERRI J LEWELLING MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E4332	AR

General Provider Information

NPI Number	:	1598753345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI J LEWELLING MD

Provider Business Mailing Address
First Line	:	PO BOX 2420
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72902-2420
Country	:	US
Telephone Number	:	479-709-7399
Fax Number	:	479-709-7053

Provider Business Practice Location Address
First Line	:	822 BROADWAY ST
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-5834
Country	:	US
Telephone Number	:	479-474-5061
Fax Number	:	479-474-0195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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