NPIMap

Organization Active NPI

Thunder Bay Community Health Service, Inc

  • Federally Qualified Health Center (FQHC)
  • Rogers City, MI
National Provider Identifier
1477591691
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
205 S Brandley Hwy
Rogers City, MI 49779
Phone
(989) 734-2052
Fax
(989) 734-7390
NPI assigned
Jun 2, 2006
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

205 S Brandley Hwy
Rogers City, MI 49779

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060111000563 MI Part A Provider - Federally Qualified Health Center (FQHC) 0143296772 Practice locations: Rogers City, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477591691. Details of each certification follow.

Federally qualified health center certification: CCN 231874

Legal name
THUNDER BAY COMMUNITY HEALTH SERVICE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 15, 2000
Last certification
Jun 15, 2000
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 7, 1980 in MI
Enrollment address
205 S Bradley Hwy
Rogers City, MI 49779-2137
Related CCNs
231808

Facilities connected through Provider of Services related, parent or unit certification numbers.

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

Locations

11899 M 32
Atlanta, MI 49709
Phone (866) 808-7540

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

4363 S Straits Hwy
Indian River, MI 49749
Phone (231) 238-6868

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 Director Jul 14, 2014
Shanna Johnson Individual Corporate Director Jul 14, 2014
Michael Bruce Fairbanks Individual Corporate Director Dec 31, 2018
Nina Kennard Individual Corporate Director Jul 14, 2014
Beach Hall Individual Corporate Director Jul 14, 2014
Benjamin Bolser Individual Corporate Director Jul 14, 2014
Jacquelyn McIntire Individual Corporate Director Jul 14, 2014
Michelle T Styma Individual Corporate OfficerCeo Jul 1, 2003 100%
W-2 Managing EmployeeCeo Jul 1, 2003 100%
Richard D Bates Individual Corporate OfficerInterim Ceo Mar 3, 2023 100%
W-2 Managing EmployeeInterim Ceo Mar 3, 2023 100%
Carrie Lohman Individual Corporate Director Dec 31, 2018
Mike Wurtsmith Individual Corporate Director Jul 14, 2014
Amy Lou Kreft Individual Corporate Director Dec 31, 2018
Aldean Moe Individual Corporate Director Jul 14, 2014
Nancy Dextrom Individual Corporate Director Jul 14, 2014
Troy Reehl Individual Corporate Director Dec 31, 2018

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785369600000",
    "number": "1477591691",
    "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": "989-742-4298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S BRANDLEY HWY",
            "city": "ROGERS CITY",
            "state": "MI",
            "postal_code": "49779",
            "telephone_number": "989-734-2052",
            "fax_number": "989-734-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THUNDER BAY COMMUNITY HEALTH SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "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": []
}

Other providers in Rogers City, MI

Sources for this page

Verify at the official NPI Registry.