| Third Street Community Clinic, Inc. | |
|
205 W Cook Rd Mansfield OH 44907-2405 | |
| (419) 522-6191 | |
| (419) 525-6723 |
| Full Name | Third Street Community Clinic, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 205 W Cook Rd, Mansfield, Ohio |
| Authorized Official Name and Position | Theresa Jeremy (CREDENTIALING) |
| Authorized Official Contact | 4195226191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Third Street Community Clinic, Inc. 600 W 3rd St Mansfield OH 44906-2633 Ph: (419) 522-6191 | Third Street Community Clinic, Inc. 205 W Cook Rd Mansfield OH 44907-2405 Ph: (419) 522-6191 |
| NPI Number | 1306499314 |
|---|---|
| Provider Enumeration Date | 07/18/2019 |
| Last Update Date | 02/25/2022 |
| Medicare PECOS PAC ID | 2365423977 |
|---|---|
| Medicare Enrollment ID | O20191211000542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306499314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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