# THUNDER BAY CLINIC MANAGEMENT INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790746964
- **Authorized official:** MRS. JANE E HARDIES (OFFICE MANAGER)
- **Authorized official phone:** (989) 354-0607

## Contact information

- **Practice address:** 1065 US 23 NORTH, ALPENA, MI 49707
- **Practice address phone:** (989) 354-0607
- **Practice address fax:** (989) 356-6710
- **Mailing address:** 1065 US 23 NORTH, ALPENA, MI 49707
- **Mailing address phone:** (989) 354-0607
- **Mailing address fax:** (989) 356-6710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | BB012930 | MI | Yes |

## Other

- **Enumeration date:** 03/29/2006
- **Last updated:** 06/25/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3438729 | — | MI |