Echelon Surgical Specialists LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

54799 Issued in MN

Legal business name

ECHELON SURGICAL SPECIALISTS LLC

Practice address

15450 Highway 7 Ste 225
Minnetonka, MN 55345-3522

Phone

(507) 383-3134

NPI assigned

Jul 5, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Carroll Camp, M.D.

Title

Ceo

Phone

(507) 383-3134

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538438400000",
    "number": "1720574445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12300 168TH ST W",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449224",
            "telephone_number": "507-383-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15450 HIGHWAY 7 STE 225",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553453522",
            "telephone_number": "507-383-3134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2934 W 66th St",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554231939",
            "country_code": "US",
            "telephone_number": "507-383-3134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ECHELON SURGICAL SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-05",
        "last_updated": "2018-10-02",
        "status": "A",
        "authorized_official_last_name": "CAMP",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "CARROLL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-383-3134",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "MN",
            "license": "54799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Plastic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; 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.