# DIAGNOSTIC CLINIC MEDICAL GROUP INC.

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

## Provider details

- **NPI number:** 1942452966
- **Authorized official:** GINA M PREBECK MD (VP OF OPERATIONS)
- **Authorized official phone:** (727) 581-8767

## Contact information

- **Practice address:** 3820 TAMPA RD, SUITE 101, PALM HARBOR, FL 34684-3609
- **Practice address phone:** (727) 785-6422
- **Practice address fax:** (727) 785-9660
- **Mailing address:** 1301 2ND AVE SW, LARGO, FL 33770-3120
- **Mailing address phone:** (727) 581-8767
- **Mailing address fax:** (727) 581-8507

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/22/2008
- **Last updated:** 11/25/2020