Healthcare Provider Details

I. General information

NPI: 1073210753
Provider Name (Legal Business Name): LEGACY MD MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 N IMPERIAL AVE
EL CENTRO CA
92243-1320
US

IV. Provider business mailing address

1699 N IMPERIAL AVE
EL CENTRO CA
92243-1320
US

V. Phone/Fax

Practice location:
  • Phone: 760-550-1685
  • Fax: 888-631-5150
Mailing address:
  • Phone: 760-550-1685
  • Fax: 888-631-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN M STRONG
Title or Position: PRESIDENT
Credential: MD
Phone: 760-550-1685