Diagnostic Clinic Medical Group Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

10D2079095 Issued in FL

Legal business name

DIAGNOSTIC CLINIC MEDICAL GROUP INC.

Practice address

1301 2ND Ave SW
Largo, FL 33770-3120

Phone

(727) 581-8767

Fax

(727) 581-8507

NPI assigned

Jan 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gina M Prebeck

Title

VP of Operations

Phone

(727) 581-8767

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1154474245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 2ND AVE SW",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703120",
            "telephone_number": "727-581-8767",
            "fax_number": "727-581-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 2ND AVE SW",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703120",
            "telephone_number": "727-581-8767",
            "fax_number": "727-581-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC CLINIC MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "PREBECK",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "727-581-8767"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "10D2079095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LAB ID#",
            "identifier": "L8189",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.