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Organization

DIAGNOSTIC CLINIC MEDICAL GROUP INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GINA M PREBECK MD (VP OF OPERATIONS)
(727) 581-8767
Entity
Organization

Contact information

Practice address
3131 N MCMULLEN BOOTH RD, CLEARWATER, FL 33761-2008
(727) 726-8871
(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
207N00000X
Dermatology Physician
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
Primary
207RG0100X
Gastroenterology Physician
207V00000X
Obstetrics & Gynecology Physician
207X00000X
Orthopaedic Surgery Physician
207Y00000X
Otolaryngology Physician
2085U0001X
Diagnostic Ultrasound Physician
208600000X
Surgery Physician
332B00000X
Durable Medical Equipment & Medical Supplies

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
260094304
FL
Enumeration date
10/22/2008
Last updated
11/25/2020
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