# DIAGNOSTIC CLINIC MEDICAL GROUP INC.

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

## Provider details

- **NPI number:** 1780080945
- **Authorized official:** GINA M PREBECK (VP OF OPERATIONS)
- **Authorized official phone:** (727) 581-8767

## Contact information

- **Practice address:** 630 PASADENA AVE S, ST PETERSBURG, FL 33707-2128
- **Practice address phone:** (727) 345-7100
- **Practice address fax:** (727) 345-7102
- **Mailing address:** 630 PASADENA AVE S, ST PETERSBURG, FL 33707-2128
- **Mailing address phone:** (727) 345-7100
- **Mailing address fax:** (727) 345-7102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/14/2014
- **Last updated:** 11/25/2020