NPIMap

Organization Active NPI

Thunder Bay Community Health Service, Inc

Doing business as Cheboygan Intermediate School

  • Federally Qualified Health Center (FQHC)
  • Cheboygan, MI
National Provider Identifier
1306244108
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
Doing business as
Cheboygan Intermediate School
Practice address
905 W Lincoln Ave
Cheboygan, MI 49721-1858
Phone
(989) 354-2197
Fax
(989) 356-6524
NPI assigned
Dec 10, 2014
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

905 W Lincoln Ave
Cheboygan, MI 49721-1858

Mailing address

PO Box 427
Hillman, MI 49746-0427
Phone (989) 354-2197

Other names 1

  • Cheboygan Intermediate School Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150216001765 MI Part A Provider - Federally Qualified Health Center (FQHC) 0143296772 Practice locations: Cheboygan, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306244108. Details of each certification follow.

Federally qualified health center certification: CCN 231051

Legal name
THUNDER BAY COMMUNITY HEALTH SERVICE INC
Doing business as
CHEBOYGAN INTERMEDIATE SCHOOLS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 23, 2015
Last certification
Feb 23, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 7, 1980 in MI
Enrollment address
905 W Lincoln Ave
Cheboygan, MI 49721-1858

Other NPIs with the same Medicare PAC ID 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2089124Thunder Bay Community Health Service, Inc905 W Lincoln Ave, Cheboygan, MI 49721Certificate of waiverDec 18, 2026

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

Locations

905 W Lincoln Ave
Cheboygan, MI 49721
Phone (231) 597-9585

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Rodney D Fullerton Individual Corporate DirectorBoard Member Apr 15, 2015
Shanna Johnson Individual Corporate DirectorBoard Member Apr 1, 2015
Michael Bruce Fairbanks Individual Corporate DirectorBoard Member Mar 1, 2022
Nina Kennard Individual Corporate DirectorBoard Member Apr 15, 2015
Beach Hall Individual Corporate DirectorBoard Member Apr 1, 2015
Benjamin Bolser Individual Corporate DirectorBoard Member Apr 1, 2015
Jacquelyn McIntire Individual Corporate DirectorBoard Member Apr 15, 2015
Richard D Bates Individual Corporate OfficerCeo Mar 3, 2023 100%
W-2 Managing EmployeeCeo Mar 3, 2023 100%
Carrie Lohman Individual Corporate DirectorBoard Member Mar 1, 2022
Mike Wurtsmith Individual Corporate DirectorBoard Member Apr 1, 2015
Aldean Moe Individual Corporate DirectorBoard Member Apr 1, 2015
Susan Stacey Individual Corporate DirectorBoard Member Mar 1, 2022
Miranda Horn Individual Corporate DirectorBoard Member Mar 1, 2022
Tommie Wolff Individual Corporate DirectorBoard Member Mar 1, 2022
Julie a Kendrick Individual Corporate DirectorBoard Member Mar 1, 2022

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1418169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785369600000",
    "number": "1306244108",
    "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": "989-354-2197",
            "fax_number": "989-356-6524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 W LINCOLN AVE",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497211858",
            "telephone_number": "989-354-2197",
            "fax_number": "989-356-6524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THUNDER BAY COMMUNITY HEALTH SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-10",
        "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": "Cheboygan Intermediate School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cheboygan Intermediate School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheboygan, MI

Sources for this page

Verify at the official NPI Registry.