Third Street Community Clinic INC

NPI #1700250511 in Shelby, Ohio

Provider Information

NPI Number: 1700250511
Entity Type: Organization
Organization Name: Third Street Community Clinic INC
Subpart: Yes (part of a larger organization)
Parent Organization: THIRD STREET COMMUNITY CLINIC INC
Primary Specialty: Clinic/Center - Federally Qualified Health Center (FQHC)
Enumeration Date: Nov 17, 2015
Last Updated: Dec 30, 2015

Practice Location

Address: 199 W MAIN ST
Address 2: 2ND FLOOR
City: Shelby
State: Ohio
ZIP Code: 44875-1490
Phone: (419) 525-6732

Authorized Official

Name: JARED POLLICK
Title: CEO
Phone: (419) 522-6191

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC)	261QF0400X	Primary

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