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Thunder Bay Community Health Service, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Onaway, MI

NPI 1821228958 · NPPES record last updated Jul 30, 2026

Key facts

NPI
1821228958
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
4549 M 33
Onaway, MI 49765-9623
Phone
(989) 733-4980
Fax
(989) 733-7064
NPI assigned
Jul 23, 2009
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 26

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

View all 26

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 41

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MI

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
Corporation · Non-profit
Incorporated
Jan 7, 1980 in MI
Enrollment address
4549 M 33
Onaway, MI 49765-9623

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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Thunder Bay Community Health Service Inc (27 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

4549 M 33
Onaway, MI 49765-9623

Mailing address

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

Other providers in Onaway, MI

All providers in Onaway, MI · Federally Qualified Health Center (FQHC) in Michigan

Sources for this page

Verify at the official NPI Registry.