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General NPI Number Information
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NPI Number | 1194200063
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Entity Type | Organization
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Legal Business Name | PORT CITY AMBULANCE SERVICE LLC
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 543 LONG POINT RD STE 104
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-8360
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Country | US
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Telephone | 843-800-1112
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Fax | 843-972-3040
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Provider Business Mailing Address
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Address Line | 222 W COLEMAN BLVD STE 124
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-3588
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Country | US
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Telephone | 843-800-1112
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Fax | 843-972-3040
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. BRIAN E PEAGLER
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Credential |
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Telephone | 843-270-2391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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