Organization
THIRD STREET COMMUNITY CLINIC, INC
Active
Other names
Mansfield Family Health
Organization subpart
No
Provider details
NPI number
Authorized official
JARED POLLICK (CEO)
(419) 526-7880
Entity
Organization
Contact information
Practice address
741 SCHOLL RD STE A, MANSFIELD, OH 44907-1571
(419) 525-6737
Mailing address
600 W 3RD ST, MANSFIELD, OH 44906-2633
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
0
—
Enumeration date
02/09/2012
Last updated
10/26/2017
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