SP PLASTIC SURGERY, LLC (NPI# 1114332301) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114332301 |
| Entity Type | Organization |
| Organization Name | SP PLASTIC SURGERY, LLC |
| Practice Address |
2805 Campus Dr Suite 485 Plymouth MN 55441-2676 |
| Practice Telephone | 6512907600 |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-06-25 |
| Authorized Official Name | STEPHANIE PENG (PRESIDENT) |
| Authorized Official Telephone | 6512907600 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | 57866 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
2805 CAMPUS DR SUITE 485 |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55441-2676 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164428223 | Wayzata Orthopedic's P.a. | Orthopaedic Surgery | 2805 Campus Dr, Ste 425, Plymouth, MN 55441-2680 | 2005-06-23 |
| 1215308622 | Lauren Joy Hager | Nurse Practitioner | 2805 Campus Dr, 125, Plymouth, MN 55441-2676 | 2015-10-12 |
| 1316340128 | Lana Abboud | Psychologist | 2805 Campus Dr, Suite 115, Plymouth, MN 55441-2676 | 2014-10-07 |
| 1598165664 | Westhealth Surgery Center LLC | Clinic/Center | 2805 Campus Dr, Plymouth, MN 55441-2676 | 2014-08-26 |
| 1144629262 | Timothy James Menden | Physical Therapist | 2805 Campus Dr, Plymouth, MN 55441-2676 | 2014-08-14 |
| 1376893818 | Colin Joseph Maguire | Dentist | 2805 Campus Dr, Plymouth, MN 55441-2676 | 2012-09-12 |
| 1235498619 | Minnesota Oncology Hematology Pa | Dietitian, Registered | 2805 Campus Dr, Suite 105, Plymouth, MN 55441-2676 | 2012-05-07 |
| 1578821997 | Andrew Steven Houghton | Family Medicine | 2805 Campus Dr, Plymouth, MN 55441-2676 | 2012-04-24 |
| 1811263551 | Jacob Joseph Haws | Physical Therapist | 2805 Campus Dr, Suite 115, Plymouth, MN 55441-2676 | 2012-03-27 |
| 1114225703 | Ness Plastic Surgery, LLC | Specialist | 2805 Campus Dr, Suite 485, Plymouth, MN 55441-2676 | 2011-03-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689190019 | The Recovery Clinic LLC | Clinic/Center | 9800 Shelard Pkwy Ste 215, Plymouth, MN 55441 | 2017-08-17 |
| 1356887186 | Katherine Marlow Bell | Dentist | 2805 Campus Dr Ste 245, Plymouth, MN 55441 | 2017-01-18 |
| 1083069538 | Mercade Waldon | Home Health Aide | 3501 Xenium Lane, Plymouth, MN 55441 | 2016-05-03 |
| 1346645538 | Phs Westhealth, Inc | Skilled Nursing Facility | 2775 Campus Drive North, Plymouth, MN 55441 | 2014-10-30 |
| 1427453125 | Samuel David Fine | Pharmacist | 4070 Goldenrod Ln, Plymouth, MN 55441 | 2014-10-24 |
| 1548672538 | Scott Aaron Schmidt | Dentist | 2720 Annapolis Circle N, Suite A, Plymouth, MN 55441 | 2014-05-23 |
| 1831498633 | Comforide Transportation Services LLC | Non-emergency Medical Transport (VAN) | 9730 37th Pl N Suite 201, Plymouth, MN 55441 | 2011-03-18 |
| 1255669271 | Tammy Kae Mehlhaus | Physician Assistant | 2855 Campus Drive, Suite 570, Plymouth, MN 55441 | 2009-12-02 |
| 1164758199 | Stephen P. Boger, Dds, Pa | Dentist | 2720 Annapolis Circle, Suite A, Plymouth, MN 55441 | 2009-10-27 |
| 1093908360 | Endodontic Professionals Pa Plymouth Endodontics | Dentist | 3401 Hwy 169 N, Plymouth, MN 55441 | 2007-08-21 |
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| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871751180 | Edward Walter Malin Iv | Plastic Surgery | 46 Obery St Ste 2, Plymouth, MA 02360-2238 | 2008-05-23 |
| 1033314943 | Tracy So Kayan | Plastic Surgery | 2805 Campus Dr Ste 485, Plymouth, MN 55441-2919 | 2007-06-19 |
| 1851346803 | Charles Noell Marvin Jr. | Plastic Surgery | 17300 5th Ave N, Plymouth, MN 55447-3594 | 2006-05-24 |
| 1588929673 | Tk Plastic Surgery, LLC | Plastic Surgery | 2805 Campus Dr Ste 485, Plymouth, MN 55441-2919 | 2012-07-05 |
| 1447567664 | Michael C. Fasching, M. D. P. A. | Plastic Surgery | 2805 Campus Dr, Suite 335, Plymouth, MN 55441-2676 | 2010-09-09 |
| 1346271988 | Michael Cloud Fasching | Plastic Surgery | 2805 Campus Dr, Suite 335, Plymouth, MN 55441-2676 | 2006-07-05 |
| 1053376228 | Richard Moss | Plastic Surgery | 110 Long Pond Rd, Suite 201, Plymouth, MA 02360-2642 | 2006-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720574445 | Echelon Surgical Specialists LLC | Plastic Surgery | 15450 Highway 7 Ste 225, Minnetonka, MN 55345-3522 | 2018-07-05 |
| 1104252022 | Bashioum Cosmetic Surgery Center, Ltd. | Plastic Surgery | 445 Lake St E Ste 210, Wayzata, MN 55391-1671 | 2013-09-24 |
| 1184994501 | James Jerome Diehl | Plastic Surgery | 10530 W Riverview Dr, Eden Prairie, MN 55347-4921 | 2012-01-02 |
| 1851690697 | Jason Dean Fowler | Plastic Surgery | 1420 London Rd Ste 101, Duluth, MN 55805-2437 | 2011-03-18 |
| 1093049348 | Harry Alvin Johnson Jr. | Plastic Surgery | 4708 Townes Road, Edina, MN 55424 | 2009-09-18 |
| 1013151430 | Jennifer Ann Cameron | Plastic Surgery | 310 Smith Ave N Ste 330, Saint Paul, MN 55102 | 2009-04-29 |
| 1538336938 | Oscar Javier Manrique Mogollon | Plastic Surgery | 5347 Scenic Oak Dr Sw, Rochester, MN 55902-2567 | 2008-05-14 |
| 1558533919 | David O. Smith | Plastic Surgery | 6545 France Ave S Ste 505, Edina, MN 55435-2116 | 2008-03-26 |
| 1447442702 | Sue-mi C Tuttle | Plastic Surgery | 401 Phalen Blvd-ms 41104h, Healthpartners Specialty Center 401, St. Paul, MN 55130-5302 | 2007-08-10 |
| 1710022363 | Peter Andrew Vogt | Plastic Surgery | 319 Barry Ave S, #300, Wayzata, MN 55391-1658 | 2007-02-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.