Third Street Community Clinic INC

NPI #1972251726 in Ontario, Ohio

Provider Information

NPI Number: 1972251726
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 - Primary Care
Enumeration Date: Mar 11, 2022
Last Updated: Mar 11, 2022

Practice Location

Address: 2131 PARK AVE W
City: Ontario
State: Ohio
ZIP Code: 44906-1226
Phone: (419) 525-6730

Authorized Official

Name: PEGGY ANDERSON
Title: CEO
Phone: (419) 526-7880

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Adult Mental Health — Adult Mental Health	261QM0850X
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X
Pharmacy - Clinic Pharmacy — Clinic Pharmacy	3336C0002X
Clinic/Center - Primary Care — Primary Care	261QP2300X	Primary

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