Organization
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA M PREBECK (VP OF OPERATIONA)
(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
207K00000X
Allergy & Immunology Physician
—
—
207L00000X
Anesthesiology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207U00000X
Nuclear Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260094300
—
FL
Enumeration date
10/05/2009
Last updated
11/25/2020
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