Provider Demographics
NPI:1194200063
Name:PORT CITY AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:PORT CITY AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEAGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-270-2391
Mailing Address - Street 1:222 W COLEMAN BLVD STE 124
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3588
Mailing Address - Country:US
Mailing Address - Phone:843-800-1112
Mailing Address - Fax:843-972-3040
Practice Address - Street 1:543 LONG POINT RD STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8360
Practice Address - Country:US
Practice Address - Phone:843-800-1112
Practice Address - Fax:843-972-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC632OtherSC DHEC