THIRD STREET COMMUNITY CLINIC INC. NPI 1629620109

NPI Information

THIRD STREET COMMUNITY CLINIC, INC. is a federally qualified health center (fqhc) clinic center in Bucyrus, OH. THIRD STREET COMMUNITY CLINIC, INC. NPI is 1629620109. The provider is registered as an organization entity type.

The provider's business location address is:

2458 STETZER RD STE A
BUCYRUS, OH
ZIP 44820-066
Phone: (419) 522-6191
Fax: (419) 525-6723

The provider's authorized official is Theresa Jeremy .
The authorized official title is Credentialing and has the following contact phone number (419) 522-6191.

The CLIA number assigned to this NPI record is 36D0880758 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/15/2019 and was last updated on 7/15/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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