Healthcare Provider Details

I. General information

NPI: 1811684913
Provider Name (Legal Business Name): REBEKAH KURTANECK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MEDICAL PARK RD STE 500
COLUMBIA SC
29203
US

IV. Provider business mailing address

3 MEDICAL PARK RD STE 500
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL97121
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: