Organization
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA M PREBECK M.D. (VP OF OPERATIONS)
(727) 581-8767
Entity
Organization
Contact information
Practice address
1301 2ND AVE SW, LARGO, FL 33770-3120
(727) 581-8767
(727) 581-8507
Mailing address
1301 2ND AVE SW, LARGO, FL 33770-3120
(727) 581-8767
(727) 581-8507
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V00EY
FLORIDA BLUE
FL
Enumeration date
01/07/2016
Last updated
11/25/2020
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