Provider Demographics
NPI:1710399266
Name:PORT CITY MEDICAL, LLC
Entity Type:Organization
Organization Name:PORT CITY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-443-7667
Mailing Address - Street 1:8053 AIRWAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-9602
Mailing Address - Country:US
Mailing Address - Phone:251-443-7667
Mailing Address - Fax:251-650-4498
Practice Address - Street 1:8053 AIRWAY PARK DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-9602
Practice Address - Country:US
Practice Address - Phone:251-443-7667
Practice Address - Fax:251-650-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1349332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies