Healthcare Provider Details

I. General information

NPI: 1063359685
Provider Name (Legal Business Name): THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 3RD ST
HILLMAN MI
49746-9213
US

IV. Provider business mailing address

PO BOX 427
HILLMAN MI
49746-0427
US

V. Phone/Fax

Practice location:
  • Phone: 989-747-8300
  • Fax: 989-318-4606
Mailing address:
  • Phone: 989-747-8300
  • Fax: 989-318-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: HEIDE BOLANOWSKI
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 989-354-2197