# PORT CITY AMBULANCE SERVICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194200063
- **Authorized official:** MR. BRIAN E PEAGLER (MANAGING MEMBER)
- **Authorized official phone:** (843) 270-2391

## Contact information

- **Practice address:** 543 LONG POINT RD STE 104, MOUNT PLEASANT, SC 29464-8360
- **Practice address phone:** (843) 800-1112
- **Practice address fax:** (843) 972-3040
- **Mailing address:** 222 W COLEMAN BLVD STE 124, MOUNT PLEASANT, SC 29464-3588
- **Mailing address phone:** (843) 800-1112
- **Mailing address fax:** (843) 972-3040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 09/26/2018
- **Last updated:** 04/19/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 632 | SC DHEC | SC |