Organization
THIRD STREET COMMUNITY CLINIC, INC.
Active
Other names
Cornerstone OB/GYN, Third Street OB/GYN
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY ANDERSON (CEO)
(419) 526-7880
Entity
Organization
Contact information
Practice address
770 BALGREEN DRIVE, SUITE 207, MANSFIELD, OH 44906-2633
(419) 522-6800
(419) 522-6816
Mailing address
1404 PARK AVE W, STE 2, MANSFIELD, OH 44906-2633
(419) 522-6191
(419) 522-0493
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3111957
—
OH
Enumeration date
05/24/2010
Last updated
10/29/2024
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