Governor'S Place Ambulatory Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1936460 Issued in OH

Legal business name

GOVERNOR'S PLACE AMBULATORY SURGERY CENTER LLC

Practice address

3025 Governors Place Blvd
Dayton, OH 45409-1330

Phone

(937) 293-5567

Fax

(937) 293-5568

NPI assigned

Aug 11, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Heidi B Donnelly, MDNPI 1861449274

Title

Owner/President Ceo

Phone

(937) 293-5567

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heidi B Donnelly, M.D.

  • MOHS-Micrographic Surgery Physician
  • Dayton, OH
  • NPI 1861449274
  NPD (past) Authorized official

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1073828315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3025 GOVERNORS PLACE BLVD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454091330",
            "telephone_number": "937-293-5567",
            "fax_number": "937-293-5568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 GOVERNORS PLACE BLVD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454091330",
            "telephone_number": "937-293-5567",
            "fax_number": "937-293-5568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOVERNOR'S PLACE AMBULATORY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/PRESIDENT CEO",
        "authorized_official_telephone_number": "937-293-5567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "1936460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Jack Gouda, M.D.
• Heather R Goudy, CT
• Katria Goudy
• Morgan Michel Goudy, DPT
• William David Gould, M.D.
• Amit Goyal, MD
• Anuj Goyal, M.D.
• Siddarth Goyal, D.O
• Amanda Grabeman
• Michael Chad Grabeman, CDCA

• Ambulatory Surgical Clinic/Center in Dayton, OH
• Providers in Dayton, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; 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.