THIRD STREET COMMUNITY CLINIC INC (NPI# 1811364706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811364706 |
| Entity Type | Organization |
| Organization Name | THIRD STREET COMMUNITY CLINIC INC |
| Other Organization Name | SHELBY HEALTH AND WELLNESS CENTER |
| Practice Address |
31 E Main St Shelby OH 44875-1262 |
| Mailing Address |
600 W 3rd St Mansfield OH 44906-2633 |
| Practice Telephone | 4195256795 |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2016-01-08 |
| Authorized Official Name | JARED POLLICK (CEO) |
| Authorized Official Telephone | 4195226191 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Shelby Health and Wellness Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245858950 | Third Street Community Clinic Inc | Clinic/Center | 200 Park Ave W, Mansfield, OH 44902-1608 | 2020-07-09 |
| 1972053452 | Third Street Community Clinic Inc | Clinic/Center | 200 Park Ave W, Mansfield, OH 44902-1608 | 2016-10-10 |
| 1588119598 | Third Street Community Clinic Inc | Clinic/Center | 124 N Linden Rd, Mansfield, OH 44906-2616 | 2016-08-19 |
| 1447619788 | Third Street Community Clinic Inc | Clinic/Center | 600 W 3rd St, Mansfield, OH 44906-2633 | 2016-02-15 |
| 1700250511 | Third Street Community Clinic Inc | Clinic/Center | 199 W Main St, 2nd Floor, Shelby, OH 44875-1490 | 2015-11-17 |
| Street Address |
31 E MAIN ST |
| City | SHELBY |
| State | OH |
| Zip Code | 44875-1262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518957331 | Virgilio Millado Tongson | Specialist | 31 E Main St, Ste 4, Shelby, OH 44875-1262 | 2005-10-24 |
| 1417506106 | Abhinav Bhatnagar | Dentist | 31 E Main St, Shelby, OH 44875-1262 | 2019-09-05 |
| 1639215114 | Ohio Cancer Specialists | Internal Medicine | 31 E Main St, Suite 2, Shelby, OH 44875-1262 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962999755 | Michael Lee Mason | Counselor | 2779 St. Rt. 39, Shelby, OH 44875 | 2018-04-17 |
| 1336646009 | Toia Branklin | Counselor | 2779 St Rt 39, Shelby, OH 44875 | 2018-04-10 |
| 1801397138 | Stephanie L Kamp | Social Worker | 29 Steele Ave, Shelby, OH 44875 | 2018-02-22 |
| 1164956744 | Brandy Brown | Licensed Practical Nurse | 2775 St. Rt. 39, Shelby, OH 44875 | 2017-04-20 |
| 1306229281 | Spencer Blevins | Specialist/Technologist | 7025 State Route 61 N, Shelby, OH 44875 | 2015-07-09 |
| 1194141150 | Karen Rittenhouse | Occupational Therapist | 109 Auburn Ave., Auburn Elementary, Shelby, OH 44875 | 2014-03-13 |
| 1467877100 | Adrianne Stumbo | Licensed Practical Nurse | 2708 Holtz Rd, Shelby, OH 44875 | 2014-03-04 |
| 1730452608 | Amy Marie Weiner | Community Health Worker | 225 West Main Street, Shelby, OH 44875 | 2012-02-22 |
| 1093038218 | Susan K Mcfarland | Licensed Practical Nurse | 77 Grand Blvd Ext, Shelby, OH 44875 | 2010-03-02 |
| 1427289362 | Mary Catherine Finnegan | Physical Therapy Assistant | 60 Grand Blvd Apt 1, Shelby, OH 44875 | 2009-07-27 |
| Find all providers in zip 44875 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366068397 | Gaston Family Health Services, Inc. | Clinic/Center | 305 W College Ave, Shelby, NC 28152-8111 | 2020-06-25 |
| 1700250511 | Third Street Community Clinic Inc | Clinic/Center | 199 W Main St, 2nd Floor, Shelby, OH 44875-1490 | 2015-11-17 |
| 1235208075 | Northwest Michigan Health Services Inc. | Clinic/Center | 119 S State St, Shelby, MI 49455-1243 | 2006-11-07 |
| 1881697209 | Marias Healthcare Services Inc | Clinic/Center | 670 Park Ave, Shelby, MT 59474-1663 | 2005-05-31 |
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| 1336777077 | Shawnee Mental Health Center Inc | Clinic/Center | 1225 Gallia St Rm 121, Portsmouth, OH 45662-4216 | 2020-03-30 |
| 1376177303 | Erie County Office of Auditor | Clinic/Center | 1925 Hayes Ave Ste B, Sandusky, OH 44870-4737 | 2020-02-28 |
| 1407480593 | Erie County Office of Auditor | Clinic/Center | 333 Buckeye Blvd Ste B, Port Clinton, OH 43452-2475 | 2020-02-27 |
| Find all providers with the same taxonomy | ||||
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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.