Provider Demographics
NPI:1508683111
Name:STALLANT MEDICAL GROUP INC
Entity type:Organization
Organization Name:STALLANT MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:STEFFENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-347-3974
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-1048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27811 GREENSPOT RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-4361
Practice Address - Country:US
Practice Address - Phone:912-347-3974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STALLANT MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health