Provider Demographics
NPI:1255300182
Name:LEVECK, TERRENCE WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:WESLEY
Last Name:LEVECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3260
Mailing Address - Country:US
Mailing Address - Phone:615-444-3027
Mailing Address - Fax:
Practice Address - Street 1:188 HOSPITAL LN
Practice Address - Street 2:JELLICO COMMUNITY HOSPITAL
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-4400
Practice Address - Country:US
Practice Address - Phone:800-944-7252
Practice Address - Fax:800-305-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20446207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC76909Medicare UPIN