=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891615449
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGACYMD SURGICAL CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2026
-----------------------------------------------------
Last Update Date | 07/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81812 DR CARREON BLVD STE F
-----------------------------------------------------
City | INDIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92201-5594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-352-2551
-----------------------------------------------------
Fax | 442-615-2060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1699 N IMPERIAL AVE
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-352-2551
-----------------------------------------------------
Fax | 442-615-2060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN M STRONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 760-352-2551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------