NPIMap

Organization Active NPI

Third Street Community Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ashland, OH
National Provider Identifier
1104461805
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THIRD STREET COMMUNITY CLINIC, INC.
Practice address
309 Arthur St
Ashland, OH 44805-3206
Phone
(567) 217-7778
Fax
(419) 525-6723
NPI assigned
Nov 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peggy Anderson
Title
Ceo
Phone
(419) 526-7880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

309 Arthur St
Ashland, OH 44805-3206

Mailing address

1404 Park Ave W Ste 2
Ontario, OH 44906-2719
Phone (419) 522-6191

Other names 1

  • Ashland Health and Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200402002948 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Ashland, OH
O20200520001554 OH Part B Supplier - Clinic/Group Practice 2365423977 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bucyrus, OH

Federally qualified health center certification: CCN 721853

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
ASHLAND HEALTH AND WELLNESS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2020
Last certification
Apr 2, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 1993 in OH
Enrollment address
309 Arthur St
Ashland, OH 44805-3206

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James Dolan Individual Corporate DirectorBoard Member Jan 23, 2018
Dorothy Stratton Individual Corporate DirectorBoard Member Aug 4, 2021
Allen Hocker Individual Corporate DirectorBoard Member May 18, 2023
Douglas Newsome Individual Corporate DirectorBoard Member May 18, 2023
Jalen Reese Individual Corporate DirectorBoard Member May 18, 2023
Brigitte Coles Individual Corporate DirectorBoard Member Oct 19, 2021
Kathy Wells Individual Corporate DirectorBoard Member Oct 19, 2023
Khushwant Pittenger Individual Corporate DirectorBoard Member Aug 4, 2021
Amber Wertman Individual Corporate DirectorBoard Member Aug 4, 2021
Peggy S Anderson Individual Corporate OfficerCeo Aug 4, 2021
Corporate DirectorBoard Member - P Aug 4, 2021
W-2 Managing EmployeeCeo Aug 4, 2021
Barrett Thomas Individual Corporate DirectorTreasurer Feb 16, 2023
Sally Gesouras Individual Corporate DirectorBoard Member Jan 18, 2024

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1104461805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W STE 2",
            "city": "ONTARIO",
            "state": "OH",
            "postal_code": "449062719",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 ARTHUR ST",
            "city": "ASHLAND",
            "state": "OH",
            "postal_code": "448053206",
            "telephone_number": "567-217-7778",
            "fax_number": "419-525-6723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-18",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-526-7880"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ashland Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ashland Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashland, OH

Sources for this page

Verify at the official NPI Registry.