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General NPI Number Information
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NPI Number | 1376447516
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Entity Type | Organization
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Legal Business Name | THIRD STREET COMMUNITY CLINIC INC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 370 CLINE AVE STE 1
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City | MANSFIELD
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State | OH
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Zip | 44907-1057
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Country | US
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Telephone | 419-522-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 PARK AVE W STE 2
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City | ONTARIO
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State | OH
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Zip | 44906-2719
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Country | US
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Telephone | 330-967-1399
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Fax |
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | JASON BILYJ
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Credential |
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Telephone | 419-522-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State | NULL
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