=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467302083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF CALAVERAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2026
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 JEFF TUTTLE RD
-----------------------------------------------------
City | SAN ANDREAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95249-9799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-754-6556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1045 JEFF TUTTLE RD
-----------------------------------------------------
City | SAN ANDREAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95249-9799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-754-6556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS ADMINISTRATOR
-----------------------------------------------------
Name | STACEY MEILY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-754-6516
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------