Thunder Bay Community Health Service, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Cheboygan, MI
NPI 1306244108 · NPPES record last updated Jul 30, 2026
Key facts
- NPI
- 1306244108
- 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
- 905 W Lincoln Ave
Cheboygan, MI 49721-1858 - Phone
- (989) 354-2197
- Fax
- (989) 356-6524
- NPI assigned
- Dec 10, 2014
- Organization subpart
- No
Authorized official
- Name
- Doug Kreis
- Title
- Ceo
- Phone
- (989) 742-4583
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 26
Practitioners 44
-
Heather Marie Bontempo, MSN, APRN, FNP-C
-
Amy Marie Brewbaker, FNP
-
Osama Ahmed, MD
-
Melissa Sue Anderson, PA-C
-
Alexis Atwell, PA-C
-
Grace Balog, PA-C
-
Jill P Barsen, P.A.C
-
Connie M Booms, FNP
-
Amy J Code, FNP
-
Brendan Conboy, MD
-
Jenna Cottrell, MSN, FNP-BC
-
Meagan Elayn Florip, LMSW
-
Bonita H. Gawel, P.A.C.
-
Julie A Gilbert, NP
-
Abigail R Godfrey, PA-C.
-
Lindsey Grace, FNP
-
Evan Steven Gravedoni, PA-C
-
Marion C Hautea, M.D.
-
Barbara M Hoose, MSN FNP-C
-
David Rex Hunter, MD
-
Veronica Ann Jung, M.S.W.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2089124 | Thunder Bay Community Health Service, Inc | Certificate of waiver | Dec 18, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
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
- Corporation · Non-profit
- Incorporated
- Jan 7, 1980 in MI
- Enrollment address
- 905 W Lincoln Ave
Cheboygan, MI 49721-1858
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Rodney D Fullerton |
Corporate Director |
Apr 15, 2015 | |
| Shanna Johnson |
Corporate Director |
Apr 1, 2015 | |
| Michael Bruce Fairbanks |
Corporate Director |
Mar 1, 2022 | |
| Nina Kennard |
Corporate Director |
Apr 15, 2015 | |
| Beach Hall |
Corporate Director |
Apr 1, 2015 | |
| Benjamin Bolser |
Corporate Director |
Apr 1, 2015 | |
| Jacquelyn McIntire |
Corporate Director |
Apr 15, 2015 | |
| Richard D Bates |
Corporate Officer |
Mar 3, 2023 | 100% |
| W-2 Managing Employee |
Mar 3, 2023 | 100% | |
| Carrie Lohman |
Corporate Director |
Mar 1, 2022 | |
| Mike Wurtsmith |
Corporate Director |
Apr 1, 2015 | |
| Aldean Moe |
Corporate Director |
Apr 1, 2015 | |
| Susan Stacey |
Corporate Director |
Mar 1, 2022 | |
| Miranda Horn |
Corporate Director |
Mar 1, 2022 | |
| Tommie Wolff |
Corporate Director |
Mar 1, 2022 | |
| Julie a Kendrick |
Corporate Director |
Mar 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150216001765 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 0143296772 | Practice locations: Cheboygan, MI |
National Provider Directory
- Tax ID family
- Thunder Bay Community Health Service Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- Cheboygan Intermediate School
Other providers in Cheboygan, MI
- Sarah Jeanne Teegardin
- Tendercare (Michigan) Inc.
- Teter Orthotics & Prosthetics Inc
- Mark Dana Thoms
- Thunder Bay Community Health Service, Inc
- Thunder Bay Community Health Service, Inc
- Tica'S Compassionate Care, LLC
- Deborah Marie Tierney
- Rechab Towne
- Tammie Travis
All providers in Cheboygan, 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 Jul 30, 2026. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.