| Diagnostic Clinic Medical Group, Inc. | |
|
1615 Pasadena Ave S Ste 220 South Pasadena FL 33707-4517 | |
| (727) 345-7100 | |
| (727) 345-7102 |
| Full Name | Diagnostic Clinic Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1615 Pasadena Ave S Ste 220, South Pasadena, Florida |
| Authorized Official Name and Position | Gina Marie Prebeck (VP OF OPERATIONS) |
| Authorized Official Contact | 7275599461 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Diagnostic Clinic Medical Group, Inc. 1615 Pasadena Ave S Ste 220 South Pasadena FL 33707-4517 Ph: (727) 345-7100 | Diagnostic Clinic Medical Group, Inc. 1615 Pasadena Ave S Ste 220 South Pasadena FL 33707-4517 Ph: (727) 345-7100 |
| NPI Number | 1851997985 |
|---|---|
| Provider Enumeration Date | 12/04/2020 |
| Last Update Date | 03/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851997985 | NPI | - | NPPES |
| 00036 | Other | FL | FLORIDA BLUE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
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