Organization
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Active
Parent organization
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Other names
Diagnostic Clinic Medical Group, Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Authorized official
GINA MARIE PREBECK (VP OF OPERATIONS)
(727) 559-9461
Entity
Organization
Contact information
Practice address
385 CYPRESS GARDENS BLVD, WINTER HAVEN, FL 33880-4452
(863) 356-3754
(863) 356-5200
Mailing address
385 CYPRESS GARDENS BLVD, WINTER HAVEN, FL 33880-4452
(863) 356-3754
(863) 356-5200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00036
FLORIDA BLUE
FL
Enumeration date
08/04/2021
Last updated
08/04/2021
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