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NPI Code Detail

MEDICARE: THUNDER BAY COMMUNITY HEALTH SERVICE, INC

MEDICARE: THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0002XClinic Pharmacy
33336C0003XCommunity/Retail Pharmacy5301007563MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22363959OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1528158441
Entity Type Code : Organization
Provider Name (Legal Business Name) : THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Provider Business Mailing Address
First Line : PO BOX 850
Second Line : 11899 M32
City : ATLANTA
State : MI
Zip : 49709-0850
Country : US
Telephone Number : 989-785-5535
Fax Number : 989-785-5267
Provider Business Practice Location Address
First Line : 11899 M 32
Second Line :
City : ATLANTA
State : MI
Zip : 49709-9374
Country : US
Telephone Number : 989-785-5535
Fax Number : 989-785-5267
Authorized Official
Title or Position : PHARMACY DIRECTOR
Name : LORI WINEMAN
Credential :
Telephone Number : 989-785-5535
Provider Enumeration Date : 10/13/2006
Last Update Date : 04/06/2017

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Directions to “THUNDER BAY COMMUNITY HEALTH SERVICE, INC ” Practice Location

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