Third Street Community Clinic Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

THIRD STREET COMMUNITY CLINIC INC

Doing business as

Shelby OB/GYN

Practice address

199 W Main St
2ND Floor
Shelby, OH 44875-1490

Phone

(419) 525-6732

NPI assigned

Nov 17, 2015

Organization subpart

Yes

Parent organization

THIRD STREET COMMUNITY CLINIC INCAs reported in NPPES

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

Authorized official

Name

Jared Pollick

Title

Ceo

Phone

(419) 522-6191

Specialties & licenses 1

Addresses

Other names 1

• Shelby OB/GYN Doing business as

Part of

Shelby OBGYN

Locations

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451433600000",
    "number": "1700250511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 W MAIN ST",
            "address_2": "2ND FLOOR",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 W MAIN ST",
            "address_2": "2ND FLOOR",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751490",
            "telephone_number": "419-525-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THIRD STREET COMMUNITY CLINIC INC",
        "enumeration_date": "2015-11-17",
        "last_updated": "2015-12-30",
        "status": "A",
        "authorized_official_last_name": "POLLICK",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-522-6191"
    },
    "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": "Shelby OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeremy Taylor, CDCA
• Evan Teaney
• Christopher Tesca
• Thi of Ohio at Heritage, LLC (Heritage Care Center)
• Third Street Community Clinic Inc (Shelby Health and Wellness Center)
• Third Street Community Clinic Inc (Shelby Health and Wellness Center)
• Third Street Community Clinic, Inc
• Stacy S Thomas, LPN
• Thu Lephan DDS, LLC
• Jenny Lynne Thurman, RD,LD

• Federally Qualified Health Center (FQHC) in Shelby, OH
• Providers in Shelby, OH by specialty
• Federally Qualified Health Center (FQHC) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.