1306535406 NPI number — THUNDER BAY COMMUNITY HEALTH SERVICE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306535406 NPI number — THUNDER BAY COMMUNITY HEALTH SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THUNDER BAY COMMUNITY HEALTH SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306535406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLMAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49746-0427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-354-2197
Provider Business Mailing Address Fax Number:
989-354-1952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1910 E MILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRVIEW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48621-8731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-848-4606
Provider Business Practice Location Address Fax Number:
989-318-4606
Provider Enumeration Date:
05/04/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WINEMAN
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
989-785-5535

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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