Healthcare Provider Details

I. General information

NPI: 1235065111
Provider Name (Legal Business Name): THUNDER BAY COMMUNITY HEALTH SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 BOUM ST
LEWISTON MI
49756-8134
US

IV. Provider business mailing address

PO BOX 427
HILLMAN MI
49746-0427
US

V. Phone/Fax

Practice location:
  • Phone: 989-354-2197
  • Fax: 989-318-4606
Mailing address:
  • Phone: 989-354-2197
  • Fax: 989-318-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DALE BATES
Title or Position: CEO
Credential:
Phone: 989-354-2197