# THIRD STREET COMMUNITY CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THIRD STREET COMMUNITY CLINIC, INC
- **Other names:** THIRD STREET OB/GYN
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1558609990
- **Legal business name:** THIRD STREET COMMUNITY CLINIC, INC
- **Authorized official:** PEGGY ANDERSON CEO (CEO)
- **Authorized official phone:** (419) 522-6191

## Contact information

- **Practice address:** 770 BALGREEN DR, MANSFIELD, OH 44906-4106
- **Practice address phone:** (419) 522-6800
- **Practice address fax:** (419) 522-6816
- **Mailing address:** 600 W 3RD ST, MANSFIELD, OH 44906-2633
- **Mailing address phone:** (419) 522-6191
- **Mailing address fax:** (419) 526-4911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 35096570 | OH | Yes |

## Other

- **Enumeration date:** 01/18/2013
- **Last updated:** 05/26/2022