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NPI Code Detail

MEDICARE: LEGACY MD MEDICAL GROUP INC

MEDICARE: LEGACY MD MEDICAL GROUP INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/Center
2103K00000XBehavior Analyst
3261QP2000XPhysical Therapy Clinic/Center
4332B00000XDurable Medical Equipment & Medical Supplies
5208D00000XGeneral Practice Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11043248719OTHERCANPI

General Provider Information

NPI Number : 1073210753
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY MD MEDICAL GROUP INC
Provider Business Mailing Address
First Line : 1699 N IMPERIAL AVE
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-1320
Country : US
Telephone Number : 760-550-1685
Fax Number : 888-631-5150
Provider Business Practice Location Address
First Line : 1699 N IMPERIAL AVE
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-1320
Country : US
Telephone Number : 760-550-1685
Fax Number : 888-631-5150
Authorized Official
Title or Position : PRESIDENT
Name : JOHN M STRONG
Credential : MD
Telephone Number : 760-550-1685
Provider Enumeration Date : 02/13/2023
Last Update Date : 02/16/2026

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Directions to “LEGACY MD MEDICAL GROUP INC ” Practice Location

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