NPIMap

Organization Active NPI

Thunder Bay Community Health Service, Inc

  • Federally Qualified Health Center (FQHC)
  • Fairview, MI
National Provider Identifier
1285281709
Registry record updated Jul 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Practice address
1910 E Miller Rd
Fairview, MI 48621-8731
Phone
(989) 848-5644
NPI assigned
Aug 20, 2019
Last updated
Jul 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2026

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

Authorized official

Name
Doug Kreis
Title
Ceo
Phone
(989) 742-4583

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1910 E Miller Rd
Fairview, MI 48621-8731

Mailing address

PO Box 427
Hillman, MI 49746-0427
Phone (989) 742-4583

Other names 1

  • Thunder Bay Community Health Service, Inc - Fairview Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191126000548 MI Part A Provider - Federally Qualified Health Center (FQHC) 0143296772 Practice locations: Fairview, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285281709. Details of each certification follow.

Federally qualified health center certification: CCN 231147

Legal name
THUNDER BAY COMMUNITY HEALTH SERVICE INC
Doing business as
THUNDER BAY COMMUNITY HEALTH SERVICE INC-FAIRVIEW
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 3, 2019
Last certification
Dec 3, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1910 E Miller Rd
Fairview, MI 48621-8731

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Thunder Bay Community Health Service Inc27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lawrence Green Individual Corporate DirectorBoard Member Jun 30, 2025
Andrew H Blinder Individual Corporate DirectorBoard Member Apr 30, 2025
Dorothea Vrouhas Individual Corporate DirectorBoard Member Mar 30, 2025
Shanna Johnson Individual Corporate DirectorBoard Member Oct 15, 2019
Renee McCune Individual Corporate DirectorBoard Member Apr 30, 2025
Kathleen Xenakis-Makowski Individual Corporate DirectorBoard Member Apr 30, 2025
Beach Hall Individual Corporate DirectorBoard Member Oct 15, 2019
Benjamin Bolser Individual Corporate DirectorBoard Member Oct 15, 2019
Kelli Stockwell Individual Corporate DirectorBoard Member Apr 30, 2025
Charles Rutenbar Individual Corporate DirectorBoard Member Apr 30, 2025
Richard D Bates Individual 5% Or Greater Indirect Ownership InterestCeo Aug 1, 2025 100%
Corporate OfficerCeo Mar 2, 2023
W-2 Managing EmployeeCeo Mar 2, 2023
Ashley Montroy Individual Corporate DirectorBoard Member Mar 30, 2025
Amy Lou Kreft Individual Corporate DirectorBoard Member Aug 1, 2025
Dona Dewolf Individual Corporate DirectorBoard Member Apr 30, 2025
Tommie Wolff Individual Corporate DirectorBoard Member Mar 30, 2025
Gary Wood Individual Corporate DirectorBoard Member Apr 30, 2025
Julie a Kendrick Individual Corporate DirectorBoard Member Mar 30, 2025

NPI Registry JSON

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

{
    "created_epoch": "1566259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785369600000",
    "number": "1285281709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 427",
            "city": "HILLMAN",
            "state": "MI",
            "postal_code": "497460427",
            "telephone_number": "989-742-4583",
            "fax_number": "989-742-2183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 E MILLER RD",
            "city": "FAIRVIEW",
            "state": "MI",
            "postal_code": "486218731",
            "telephone_number": "989-848-5644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THUNDER BAY COMMUNITY HEALTH SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-20",
        "last_updated": "2026-07-30",
        "certification_date": "2026-07-30",
        "status": "A",
        "authorized_official_last_name": "KREIS",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-742-4583"
    },
    "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": "Thunder Bay Community Health Service, Inc - Fairview",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Thunder Bay Community Health Service, Inc - Fairview",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fairview, MI

Sources for this page

Verify at the official NPI Registry.