NPIMap

Organization Active NPI

Thunder Bay Community Health Service, Inc

  • Federally Qualified Health Center (FQHC)
  • Onaway, MI
National Provider Identifier
1821228958
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
4549 M 33
Onaway, MI 49765-9623
Phone
(989) 733-4980
Fax
(989) 733-7064
NPI assigned
Jul 23, 2009
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

4549 M 33
Onaway, MI 49765-9623

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 MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20090915000161 MI Part A Provider - Federally Qualified Health Center (FQHC) 0143296772 Practice locations: Onaway, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821228958. Details of each certification follow.

Federally qualified health center certification: CCN 231944

Legal name
THUNDER BAY COMMUNITY HEALTH SERVICE INC
Doing business as
THUNDER BAY COMMUNITY HEALTH SERVICE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 29, 2009
Last certification
Oct 29, 2009
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 7, 1980 in MI
Enrollment address
4549 M 33
Onaway, MI 49765-9623

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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 16

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 Nov 14, 2012
Shanna Johnson Individual Corporate Director Nov 14, 2012
Michael Bruce Fairbanks Individual Corporate Director Apr 1, 2016
Nina Kennard Individual Corporate Director Nov 14, 2012
Beach Hall Individual Corporate Director Nov 14, 2012
Benjamin Bolser Individual Corporate Director Nov 14, 2012
Jacquelyn McIntire Individual Corporate Director Nov 14, 2012
Richard D Bates Individual Corporate Officer Mar 3, 2023
W-2 Managing Employee Mar 3, 2023
Carrie Lohman Individual Corporate Director Nov 14, 2012
Mike Wurtsmith Individual Corporate Director Nov 14, 2012
Aldean Moe Individual Corporate Director Nov 14, 2012
Susan Stacey Individual Corporate Director Nov 14, 2012
Nancy Dextrom Individual Corporate Director Nov 14, 2012
Miranda Horn Individual Corporate Director Feb 28, 2022
Tommie Wolff Individual Corporate Officer Apr 1, 2016
Corporate Director Jul 28, 2021
Julie a Kendrick Individual Corporate Director Nov 14, 2012

Practitioners & affiliated clinicians

Practitioners 5

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": "1248307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785369600000",
    "number": "1821228958",
    "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": "4549 M 33",
            "city": "ONAWAY",
            "state": "MI",
            "postal_code": "497659623",
            "telephone_number": "989-733-4980",
            "fax_number": "989-733-7064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THUNDER BAY COMMUNITY HEALTH SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-23",
        "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 Onaway, MI

Sources for this page

Verify at the official NPI Registry.