Calaveras Emergency Physicians,

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

CALAVERAS EMERGENCY PHYSICIANS,

Practice address

768 Mountain Ranch Rd
San Andreas, CA 95249-9707

Phone

(209) 754-3251

NPI assigned

May 17, 2011

Last updated

Feb 10, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles T Mitchell, MD

Title

President

Phone

(469) 401-2386

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391990400000",
    "number": "1003109570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13737 NOEL RD",
            "address_2": "STE 1600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752401331",
            "telephone_number": "469-401-2386",
            "fax_number": "214-712-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 MOUNTAIN RANCH RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499707",
            "telephone_number": "209-754-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALAVERAS EMERGENCY PHYSICIANS,",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-17",
        "last_updated": "2014-02-10",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-401-2386",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Lynn Buetow, LPCC 23558
• Jessica Renee Burke
• Samantha Jolene Bush, LMFT
• Calaveras County (Calaveras County Behavioral Health Children)
• Calaveras County Substance Abuse Program
• Calaveras Sleep Diagnostics, LLC
• Calaveras Unified School District
• Leslie Calestini
• California Em-I Medical Services, a Medical Corporation
• Rebecca Carrillo, M.D.

• Emergency Medicine Physician in San Andreas, CA
• Providers in San Andreas, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.