1144130071 NPI number — THIRD STREET COMMUNITY CLINIC, INC

NPI Number: 1144130071
Health Care Provider/Practitioner: THIRD STREET COMMUNITY CLINIC, INC

NPI Number : 1144130071 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144130071",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "THIRD STREET COMMUNITY CLINIC, INC",
    "ParentOrgTIN": null,
    "OrgName": "THIRD STREET COMMUNITY CLINIC, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1404 PARK AVE W STE 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ONTARIO",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44906-2719",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "31 E MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHELBY",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44875-1262",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "419-525-6729",
    "PracticeLocationAddressFaxNumber": "419-730-3590",
    "EnumerationDate": "09/11/2026",
    "LastUpdateDate": "09/11/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ANDERSON",
    "AuthorizedOfficialFirstName": "PEGGY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "419-526-7880",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336C0002X",
          "TaxonomyName": "Clinic Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "3336I0012X",
          "TaxonomyName": "Institutional Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336M0002X",
          "TaxonomyName": "Mail Order Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336M0003X",
          "TaxonomyName": "Managed Care Organization Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}