NPIMap

Organization Active NPI

Third Street Community Clinic, Inc.

Doing business as Third Street Family Health Services

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
National Provider Identifier
1336252519
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.
Doing business as
Third Street Family Health Services
Practice address
600 W. Third Street
Mansfield, OH 44906-2633
Phone
(419) 522-6191
Fax
(419) 526-7939
NPI assigned
Aug 15, 2006
Last updated
May 19, 2026By the provider in NPPES
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Clinic Pharmacy 3336C0002X NU

Addresses

Primary practice location

600 W. Third Street
Mansfield, OH 44906-2633

Mailing address

1404 Park Ave W
Ste 2
Mansfield, OH 44906-2633
Phone (419) 522-6191

Other identifiers 1

IdentifierTypeStateIssuer
2069452MedicaidOH

Other names 1

  • Third Street Family Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080307000494 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Mansfield, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336252519. Details of each certification follow.

Federally qualified health center certification: CCN 361877

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
THIRD STREET FAMILY HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 2000
Last certification
Dec 8, 2000
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 18, 1994 in OH
Enrollment address
600 W 3Rd St
Mansfield, OH 44906-2633

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Barbara Sullinger Individual Corporate OfficerCfo Jan 28, 2013
W-2 Managing EmployeeCfo Jan 28, 2013
James Dolan Individual Corporate DirectorBoard Member Jan 23, 2018
Dorothy Stratton Individual Corporate DirectorBoard Member Jul 27, 2021
Sheng Liu Individual Corporate DirectorCco Jan 10, 2023
W-2 Managing EmployeeCco Jan 10, 2023
Allen Hocker Individual Corporate DirectorBoard Member May 18, 2023
Douglas Newsome Individual Corporate DirectorBoard Member May 18, 2023
Joe Stafford Individual Corporate DirectorBoard Member Oct 19, 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
Cindy Wetterau Individual Corporate DirectorBoard Member Oct 19, 2023
Khushwant Pittenger Individual Corporate DirectorBoard Member Jul 27, 2021
Julie Chaya Individual Corporate DirectorBoard Member Apr 21, 2022
Tom Walker Individual Corporate DirectorBoard Member Oct 19, 2023
Amber Wertman Individual Corporate DirectorBoard Member Jul 27, 2021
Cody Albert Individual Corporate DirectorBoard Member Jul 27, 2021
Peggy S Anderson Individual Corporate OfficerCeo Jul 27, 2021
Corporate DirectorBoard Member - P Jul 27, 2021
W-2 Managing EmployeeCeo Jul 27, 2021
Joe Devany Individual Corporate DirectorBoard Member Oct 19, 2023
Barrett Thomas Individual Corporate DirectorTreasurer Feb 16, 2023
Javar Jackson Individual Corporate OfficerCoo Jul 21, 2021
Corporate Director Jul 27, 2021
W-2 Managing EmployeeCoo Jul 27, 2021
Sally Gesouras Individual Corporate DirectorBoard Member Jan 18, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1336252519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W",
            "address_2": "STE 2",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-526-7939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W. THIRD STREET",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-526-7939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2069452",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Third Street Family Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Third Street Family Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.