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General NPI Number Information
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NPI Number | 1356939284
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC CLINIC MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 7005 4TH ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702-5909
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Country | US
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Telephone | 727-501-7300
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Fax | 727-501-7360
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Provider Business Mailing Address
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Address Line | 7005 4TH ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702-5909
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Country | US
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Telephone | 727-501-7300
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Fax | 727-501-7360
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | GINA MARIE PREBECK
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Credential |
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Telephone | 727-559-9461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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