Thunder Bay Community Health Service, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Hillman, MI
NPI 1063788909 · NPPES record last updated Mar 13, 2023
Key facts
- NPI
- 1063788909
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- THUNDER BAY COMMUNITY HEALTH SERVICE, INC
- Practice address
- 245 E Third St
Hillman, MI 49746-9213 - Phone
- (989) 742-4537
- Fax
- (989) 742-4298
- NPI assigned
- Mar 26, 2012
- Organization subpart
- No
Authorized official
- Name
- Richard Bates
- Title
- Interim Ceo
- Phone
- (989) 742-4583
Other NPIs on the same Medicare enrollment 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040907000045 | MI | Part B Supplier - Clinic/Group Practice | 0143296772 |
Receives reassigned benefits from 72 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Hillman, MI; Rogers City, MI; Onaway, MI; Alpena, MI; Atlanta, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
245 E Third St
Hillman, MI 49746-9213
Mailing address
P.O. Box 427
Hillman, MI 49746-0427
Phone (989) 742-4583
Other providers in Hillman, MI
- Courtney E Sauer-Metzke
- Shasta Sitton
- Jacek P Szydlo
- Melanie Thomas
- Thunder Bay Community Health Service, Inc
- Thunder Bay Community Health Service, Inc
- Thunder Bay Community Health Service, Inc
- Thunder Bay Community Health Service, Inc
- Thunder Bay Community Health Service, Inc
- Thunder Bay Community Health Service, Inc
All providers in Hillman, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.