Provider Demographics
NPI:1285494351
Name:LEGACY MD MEDICAL GROUP INC
Entity type:Organization
Organization Name:LEGACY MD MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-550-1685
Mailing Address - Street 1:222 E COLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-3211
Mailing Address - Country:US
Mailing Address - Phone:760-550-1685
Mailing Address - Fax:442-615-2060
Practice Address - Street 1:222 E COLE BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-3211
Practice Address - Country:US
Practice Address - Phone:760-550-1685
Practice Address - Fax:442-615-2060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY MD MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac RehabilitationGroup - Multi-Specialty