Provider Demographics
NPI:1407890932
Name:SMITH, REBECCA STARR (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:STARR
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1409 W GEORGIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6419
Practice Address - Country:US
Practice Address - Phone:864-454-5000
Practice Address - Fax:864-454-5005
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571004971025OtherBCBS OF SC ID
SC3287549OtherCIGNA ID
SCT73827Medicaid
SC080184139OtherRR MEDICARE
SC7525361OtherAETNA ID
SCT73827Medicaid
SCH411397951Medicare PIN