Organization
THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BATES (INTERIM CEO)
(989) 742-4583
Entity
Organization
Contact information
Practice address
15774 STATE STREET, HILLMAN, MI 49746
(989) 742-4583
(989) 742-4298
Mailing address
PO BOX 427, HILLMAN, MI 49746-0427
(989) 742-4583
(989) 742-4298
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F06016
MEDICARE BILL PAY TO
MI
Enumeration date
03/05/2007
Last updated
03/13/2023
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