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General NPI Number Information
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NPI Number | 1790746964
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Entity Type | Organization
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Legal Business Name | THUNDER BAY CLINIC MANAGEMENT INC
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 1065 US 23 NORTH
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City | ALPENA
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State | MI
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Zip | 49707
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Country | US
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Telephone | 989-354-0607
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Fax | 989-356-6710
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Provider Business Mailing Address
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Address Line | 1065 US 23 NORTH
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City | ALPENA
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State | MI
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Zip | 49707
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Country | US
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Telephone | 989-354-0607
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Fax | 989-356-6710
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JANE E HARDIES
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Credential |
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Telephone | 989-354-0607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | BB012930
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License Number State | MI
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