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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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1952430035
Entity Type Code : Organization
Provider Name (Legal Business Name) : THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Provider Business Mailing Address
First Line : PO BOX 427
Second Line :
City : HILLMAN
State : MI
Zip : 49746-0427
Country : US
Telephone Number : 989-742-4583
Fax Number : 989-742-4298
Provider Business Practice Location Address
First Line : 11899 M 32
Second Line :
City : ATLANTA
State : MI
Zip : 49709-9374
Country : US
Telephone Number : 989-785-4855
Fax Number : 989-785-2267
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MICHELLE STYMA
Credential :
Telephone Number : 989-742-4583
Provider Enumeration Date : 03/05/2007
Last Update Date : 04/06/2017

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

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