Port City Ambulance Service LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

PORT CITY AMBULANCE SERVICE LLC

Practice address

543 Long Point Rd Ste 104
Mount Pleasant, SC 29464-8360

Phone

(843) 800-1112

Fax

(843) 972-3040

NPI assigned

Sep 26, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brian E Peagler

Title

Managing Member

Phone

(843) 270-2391

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1194200063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W COLEMAN BLVD STE 124",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643588",
            "telephone_number": "843-800-1112",
            "fax_number": "843-972-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "543 LONG POINT RD STE 104",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294648360",
            "telephone_number": "843-800-1112",
            "fax_number": "843-972-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT CITY AMBULANCE SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-26",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "PEAGLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "843-270-2391",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC DHEC",
            "identifier": "632",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Podaris Group LLC
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• Casey Polt, PHARMACIST
• Theresa Marie Ponessa, RN
• Olivia Porpora
• Polly Porter-Campbell, RN
• Ryan William Porter, DPT
• Portner Medical PC
• Marvin M Portner, M.D.
• Toya Pound, MD

• Land Ambulance in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Land Ambulance in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.