Healthcare Provider Details

I. General information

NPI: 1891615449
Provider Name (Legal Business Name): LEGACYMD SURGICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81812 DR CARREON BLVD STE F
INDIO CA
92201-5594
US

IV. Provider business mailing address

1699 N IMPERIAL AVE
EL CENTRO CA
92243-1320
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-2551
  • Fax: 442-615-2060
Mailing address:
  • Phone: 760-352-2551
  • Fax: 442-615-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN M STRONG
Title or Position: PRESIDENT
Credential: MD
Phone: 760-352-2551