Healthcare Provider Details

I. General information

NPI: 1164558755
Provider Name (Legal Business Name): PORT CITY MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 RANGELINE RD STE 110
THEODORE AL
36582-5231
US

IV. Provider business mailing address

6215 RANGELINE RD STE 110
THEODORE AL
36582-5231
US

V. Phone/Fax

Practice location:
  • Phone: 251-443-7667
  • Fax: 251-650-4498
Mailing address:
  • Phone: 251-443-7667
  • Fax: 251-650-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number741
License Number StateAL

VIII. Authorized Official

Name: AHMET SEDAT KACAR
Title or Position: PRESIDENT
Credential:
Phone: 251-443-7667