THIRD STREET COMMUNITY CLINIC, INC (NPI# 1558609990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558609990 |
| Entity Type | Organization |
| Organization Name | THIRD STREET COMMUNITY CLINIC, INC |
| Other Organization Name | THIRD STREET OB/GYN |
| Practice Address |
770 Balgreen Dr Mansfield OH 44906-4106 |
| Mailing Address |
600 W 3rd St Mansfield OH 44906-2633 |
| Practice Telephone | 4195226800 |
| Practice Fax Number | 4195226816 |
| Mailing Telephone | 4195226191 |
| Mailing Fax Number | 4195264911 |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2013-01-18 |
| Authorized Official Name | MR. JARED POLLICK (CEO) |
| Authorized Official Telephone | 4195226191 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | Y |
| Parent Organization Name | THIRD STREET COMMUNITY CLINIC, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | 35096570 | OH | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 35088484 | OH | Allopathic & Osteopathic Physicians |
| Y | 207V00000X | Obstetrics & Gynecology | 35075677A | OH | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| THIRD STREET OB/GYN | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336411156 | Third Street Community Clinic, Inc | Clinic/Center | 741 Scholl Rd Ste A, Mansfield, OH 44907-1571 | 2012-02-09 |
| 1558576116 | Third Street Community Clinic, Inc | Clinic/Center | 770 Balgreen Dr Ste 207, Mansfield, OH 44906-4106 | 2007-05-14 |
| 1720407554 | Third Street Community Clinic, Inc | Pediatrics | 270 Sterkel Blvd, Suite A, Mansfield, OH 44907-1508 | 2014-04-09 |
| Street Address |
770 BALGREEN DR |
| City | MANSFIELD |
| State | OH |
| Zip Code | 44906-4106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821099615 | Christ John Ticoras | Dermatology | 770 Balgreen Dr, Ste 201, Mansfield, OH 44906-4106 | 2005-08-03 |
| 1124478425 | Jeffrey M. Walthour | Pharmacist | 770 Balgreen Dr, Suite 104, Mansfield, OH 44906-4106 | 2016-06-16 |
| 1396147831 | Kristyn Livorno | Audiologist | 770 Balgreen Dr, Ste. 209, Mansfield, OH 44906-4106 | 2014-09-16 |
| 1093085466 | William Scott Ballinger,m.d. | Internal Medicine | 770 Balgreen Dr, Suite 203, Mansfield, OH 44906-4106 | 2012-01-03 |
| 1316225618 | Ent Central LLC | Otolaryngology | 770 Balgreen Dr, Suite 209, Mansfield, OH 44906-4106 | 2011-08-03 |
| 1023306263 | Lab One of Ohio Inc | Clinical Medical Laboratory | 770 Balgreen Dr, Mansfield, OH 44906-4106 | 2011-07-20 |
| 1093984767 | Walter G. Bodjanac, Do, LLC | Plastic Surgery | 770 Balgreen Dr, Suite 109, Mansfield, OH 44906-4106 | 2008-02-26 |
| 1679766034 | Mykola O. Prykhodko | Otolaryngology | 770 Balgreen Dr, Suite 209, Mansfield, OH 44906-4106 | 2007-08-20 |
| 1003030883 | Midwestern Cardiac Surgery, Inc. | Specialist | 770 Balgreen Dr, Suite 107, Mansfield, OH 44906-4106 | 2007-04-12 |
| 1306958723 | Cornerstone Ob-gyn, Inc | Obstetrics & Gynecology | 770 Balgreen Dr, Suite 207, Mansfield, OH 44906-4106 | 2006-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154920155 | Jonathan Clevenger | Pharmacist | 1455 North Lexington-springmill Road, Ontario, OH 44906 | 2020-10-21 |
| 1366083297 | Jennifer Robin Young | Technician | 60 Sherman Ave, Mansfield, OH 44906 | 2019-10-02 |
| 1639721905 | Lora Harris | Nurse Practitioner | 1029 S. Trimble Rd, Mansfield, OH 44906 | 2019-07-16 |
| 1871098855 | Med Gear Plus, LLC | Durable Medical Equipment & Medical Supplies | 1041 Park Ave W, Mansfield, OH 44906 | 2018-03-29 |
| 1912401209 | Bradley Anderson | Dietitian, Registered | 1025 South Trimble Rd., Mansfield, OH 44906 | 2018-03-21 |
| 1104325182 | Nancy Labaki | Speech-Language Pathologist | 2011 W. Fourth St., Mansfield, OH 44906 | 2018-02-06 |
| 1720518319 | Stephen Anderson | Counselor | 680 Park Ave W., Mansfield, OH 44906 | 2017-06-15 |
| 1427422518 | Jill A Waite | Counselor | 33 S. Lexington-springmill Road, Mansfield, OH 44906 | 2015-11-30 |
| 1992125397 | Taryn Boyd | Physical Therapist | 1025 S Trimble, Mansfield, OH 44906 | 2014-04-24 |
| 1356760870 | Sarah Brandyberry | Social Worker | 1025 S. Trimble Rd., Mansfield, OH 44906 | 2014-04-11 |
| Find all providers in zip 44906 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194385112 | Jasma Griffin | Obstetrics & Gynecology | 1200 Highway 287 N Ste 103, Mansfield, TX 76063-2874 | 2019-06-20 |
| 1295205037 | Paul W. Daum, M.d., P.l.l.c. | Obstetrics & Gynecology | 2800 E Broad St Ste 412, Mansfield, TX 76063-6414 | 2018-12-04 |
| 1992191829 | Bhavisha Bhakta Nunez | Obstetrics & Gynecology | 120 N Miller Rd Unit 300, Mansfield, TX 76063-9173 | 2015-04-07 |
| 1871912535 | Ruth Okiemute Arumala | Obstetrics & Gynecology | 1759 Broad Park Cir S Ste 101, Mansfield, TX 76063-7836 | 2014-04-09 |
| 1134562945 | Jessica Pearce | Obstetrics & Gynecology | 120 N Miller Rd Ste 300, Mansfield, TX 76063-9173 | 2013-04-10 |
| 1205126109 | Robin Patrice Kindred | Obstetrics & Gynecology | 2800 E Broad St Ste 212, Mansfield, TX 76063-6411 | 2011-04-12 |
| 1023288701 | Mansfield Obgyn Association | Obstetrics & Gynecology | 1770 E Broad St Suite 102, Mansfield, TX 70063 | 2008-03-10 |
| 1972709533 | Marian Zinnante, Md Pa | Obstetrics & Gynecology | 120 N. Miller Rd., Suite 300, Mansfield, TX 76063-9173 | 2007-06-21 |
| 1568518173 | Natalie Kathleen Moore | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-01-26 |
| 1447332473 | Erin Carpenter Westerholm | Obstetrics & Gynecology | 2800 East Broad Street, Suite 308, Mansfield, TX 76063 | 2006-10-19 |
| Find all providers in MANSFIELD | ||||
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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.