Organization
DIAGNOSTIC CLINIC MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA M PREBECK (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
291U00000X
Clinical Medical Laboratory
Primary
10D2079095
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L8189
MEDICARE LAB ID#
FL
Enumeration date
01/19/2007
Last updated
11/25/2020
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