Healthcare Provider Details

I. General information

NPI: 1366082463
Provider Name (Legal Business Name): STALLANT MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E WASHINGTON BLVD
CRESCENT CITY CA
95531-8342
US

IV. Provider business mailing address

PO BOX 518
WEIMAR CA
95736-0518
US

V. Phone/Fax

Practice location:
  • Phone: 707-460-1802
  • Fax:
Mailing address:
  • Phone: 707-460-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT STEFFENS
Title or Position: COO
Credential:
Phone: 707-460-1802