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Organization
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Active
Organization
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA MARIE PREBECK (VP OF OPERATIONS)
(727) 559-9461
Entity
Organization
Contact information
Practice address
7005 4TH ST N, SAINT PETERSBURG, FL 33702-5909
(727) 501-7300
(727) 501-7360
Mailing address
7005 4TH ST N, SAINT PETERSBURG, FL 33702-5909
(727) 501-7300
(727) 501-7360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00036
FLORIDA BLUE
FL
Enumeration date
01/06/2021
Last updated
01/06/2021
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